EFFECTS OF PENTOXIFYLLINE ON HEMODYNAMICS AND OXYGENATION IN SEPTIC AND NONSEPTIC PATIENTS

Objective: To evaluate the effects of pentoxifylline on hemodynamics a nd systemic oxygenation in septic and nonseptic critically ill patient s. Design: Prospective clinical investigation. Setting: Intensive care unit (ICU) of a university hospital. Patients: Nineteen critically il l patients were included in the study 1 to 4 days after their admissio n to the ICU. A systemic inflammatory response syndrome was present in 12 patients, fulfilling at least two of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference cri teria. The other seven patients did not fulfill these criteria and wer e classified as nonseptic. Interventions: All patients were mechanical ly ventilated. The dosage of catecholamines was kept constant during t he entire study period and at least during 15 mins before the start of the study. In both study groups, pulmonary and radial artery catheter s were inserted and 5 mg/kg of pentoxifylline (diluted in 300 mL of ph ysiologic saline) was intravenously administered over a period of 180 mins at a rate of 100 mL/hr. Measurements and Main Results: Hemodynami c variables, oxygen transport (Do(2)), oxygen uptake (Vo(2)), and oxyg en extraction ratio were determined before pentoxifylline, after 2.5 m g/kg of pentoxifylline, after 5 mg/kg of pentoxifylline, and 60 mins a fter the termination of pentoxifylline. Repeated-measures analysis of variance and Mann-Whitney test were used for statistical analysis. At baseline, there were significant differences between the septic and th e nonseptic groups in mean pulmonary arterial pressure (septic: 31 +/- 5 mm Hg; nonseptic: 26 +/- 7 mm Hg, p < .05), and pulmonary vascular resistance index (PVRI) (septic: 344 +/- 121 dyne.sec/cm(5).m(2); nons eptic: 233 +/- 100 dyne.sec/cm(5).m(2), p < .05). In the septic group, significant increases in heart rate and cardiac index were observed. Systemic vascular resistance index and PVRI decreased. No significant changes in hemodynamic variables occurred in the nonseptic group. In b oth groups, Do(2) and Vo(2) increased significantly, while oxygen extr action ratio remained unchanged. Conclusions: The administration of pe ntoxifylline to septic patients results in a significant improvement i n hemodynamic performance compared with critically ill nonseptic patie nts. The better hemodynamic state is accompanied by an increase in Do( 2) acid Vo(2) with unchanged oxygen extraction ratio.