Vasopressin and renin-angiotensin maintain arterial pressure during PEEP in nonexpanded, conscious dogs. 1996

G Kaczmarczyk, and S Vogel, and M Krebs, and H Bünger, and A Scholz
Arbeitsgruppe Experimentelle Anästhesie, Virchow-Klinikum, Humboldt-Universität zu Berlin, Germany.

Increases of plasma arginine vasopressin (AVP) and plasma renin activity (PRA) during controlled mechanical ventilation (CMV) with positive end-expiratory pressure (PEEP) induce positive fluid balances by decreasing renal excretion. We investigated whether elevated levels of AVP and/or PRA maintain mean arterial pressure (MAP) during PEEP under conditions where plasma volume is not expanded. Six conscious chronically tracheotomized beagle dogs, kept under standardized conditions, were investigated in four protocols. They were 1) control: 1 h spontaneous breathing with a continuous positive airway pressure of 4 cmH2O (CPAP 4) followed by 2 h CMV with PEEP, resulting in a mean airway pressure of approximately 20 cmH2O (CMV 20 referred to as "PEEP"); 2) vasopressin blockade: 1 h CPAP 4, 2 h PEEP after intravenous application of an AVP V1-receptor antagonist (AVPA); 3) converting enzyme inhibition: 1 h CPAP 4, 2 h PEEP plus angiotensin-converting enzyme inhibition (ACEI); and 4) combined blockade: 1 h CPAP 4, 2 h PEEP plus AVPA + ACEI. In AVPA + ACEI, MAP decreased during PEEP from 101 +/- 4 to 75 +/- 10 mmHg, glomerular filtration rate (GFR) decreased from 3.6 +/- 0.3 to 1.7 +/- 0.7 ml.min-1.kg body wt-1, heart rate increased from 95 +/- 10 to 122 +/- 7 beats/min, plasma aldosterone increased from 62 +/- 26 to 353 +/- 63 pg/ml, plasma epinephrine increased from 81 +/- 15 to 352 +/- 89 pg/ml (all changes P < 0.05), and plasma norepinephrine did not change. Neither MAP nor GFR changed during PEEP in control experiments in which both PRA and AVP increased, in AVPA experiments in which PRA increased, or in ACEI experiments in which AVP increased. We conclude that both AVP and angiotensin II contribute to the maintenance of MAP and GFR during PEEP. When both hormones are inhibited, no immediate compensation exists to prevent an acute fall in MAP and GFR.

UI MeSH Term Description Entries
D007668 Kidney Body organ that filters blood for the secretion of URINE and that regulates ion concentrations. Kidneys
D011175 Positive-Pressure Respiration A method of mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lungs at the end of expiration, thus reducing the shunting of blood through the lungs and improving gas exchange. Positive End-Expiratory Pressure,Positive-Pressure Ventilation,End-Expiratory Pressure, Positive,End-Expiratory Pressures, Positive,Positive End Expiratory Pressure,Positive End-Expiratory Pressures,Positive Pressure Respiration,Positive Pressure Ventilation,Positive-Pressure Respirations,Positive-Pressure Ventilations,Pressure, Positive End-Expiratory,Pressures, Positive End-Expiratory,Respiration, Positive-Pressure,Respirations, Positive-Pressure,Ventilation, Positive-Pressure,Ventilations, Positive-Pressure
D012084 Renin-Angiotensin System A BLOOD PRESSURE regulating system of interacting components that include RENIN; ANGIOTENSINOGEN; ANGIOTENSIN CONVERTING ENZYME; ANGIOTENSIN I; ANGIOTENSIN II; and angiotensinase. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming ANGIOTENSIN I. Angiotensin-converting enzyme, contained in the lung, acts on angiotensin I in the plasma converting it to ANGIOTENSIN II, an extremely powerful vasoconstrictor. Angiotensin II causes contraction of the arteriolar and renal VASCULAR SMOOTH MUSCLE, leading to retention of salt and water in the KIDNEY and increased arterial blood pressure. In addition, angiotensin II stimulates the release of ALDOSTERONE from the ADRENAL CORTEX, which in turn also increases salt and water retention in the kidney. Angiotensin-converting enzyme also breaks down BRADYKININ, a powerful vasodilator and component of the KALLIKREIN-KININ SYSTEM. Renin-Angiotensin-Aldosterone System,Renin Angiotensin Aldosterone System,Renin Angiotensin System,System, Renin-Angiotensin,System, Renin-Angiotensin-Aldosterone
D001794 Blood Pressure PRESSURE of the BLOOD on the ARTERIES and other BLOOD VESSELS. Systolic Pressure,Diastolic Pressure,Pulse Pressure,Pressure, Blood,Pressure, Diastolic,Pressure, Pulse,Pressure, Systolic,Pressures, Systolic
D004285 Dogs The domestic dog, Canis familiaris, comprising about 400 breeds, of the carnivore family CANIDAE. They are worldwide in distribution and live in association with people. (Walker's Mammals of the World, 5th ed, p1065) Canis familiaris,Dog
D005260 Female Females
D005919 Glomerular Filtration Rate The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to INULIN clearance. Filtration Rate, Glomerular,Filtration Rates, Glomerular,Glomerular Filtration Rates,Rate, Glomerular Filtration,Rates, Glomerular Filtration
D006439 Hemodynamics The movement and the forces involved in the movement of the blood through the CARDIOVASCULAR SYSTEM. Hemodynamic
D006727 Hormone Antagonists Chemical substances which inhibit the function of the endocrine glands, the biosynthesis of their secreted hormones, or the action of hormones upon their specific sites. Antagonists, Hormone
D006728 Hormones Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various ENDOCRINE GLANDS and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. Hormone,Hormone Receptor Agonists,Agonists, Hormone Receptor,Receptor Agonists, Hormone

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