INCREASED PLASMA-CONCENTRATIONS OF ADRENOMEDULLIN CORRELATE WITH RELAXATION OF VASCULAR TONE IN PATIENTS WITH SEPTIC SHOCK

Objective: To investigate plasma concentrations of adrenomedullin in p atients with septic shock and the potential association of these conce ntrations with relaxation of vascular tone, Design: Prospective, case series, Setting: Department of Emergency and Critical Care Medicine, N ara Medical University, Patients: Twelve patients who fulfilled the cl inical criteria for severe sepsis or septic shock (as defined by the M embers of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee) and 13 healthy voluntee rs, Interventions: Arterial blood samples were obtained via a 20-gauge cannula inserted into each patient's radial artery, Measurements and Main Results: After extraction and purification, plasma adrenomedullin was measured by radioimmunoassay. Systemic vascular resistance index, pulmonary vascular resistance, cardiac index, and stroke volume index were determined with a thermodilution catheter, The mean plasma conce ntration of adrenomedullin was markedly higher in patients than in con trols (226.1 +/- 66.4 [SEM] VS, 5.05 +/- 0.21 fmol/mL, p < .01), Moreo ver, these concentrations correlated significantly with cardiac index, stroke volume index, and heart rate values, and correlated significan tly with decreases in diastolic blood pressure, systemic vascular resi stance index, and pulmonary vascular resistance index values, Conclusi ons: Enhanced production of adrenomedullin in patients with septic sho ck may contribute to reduced vascular tone, hypotension, or both, More data are needed to clarify the role of adrenomedullin in the regulati on of vascular tone in this patient population.