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May 22, 1967

Therapeutic Advantages of an Inotropic Vasodilator in Endotoxin Shock

Author Affiliations

From the Department of Surgery, Albert Einstein College of Medicine, New York.

JAMA. 1967;200(8):696-704. doi:10.1001/jama.1967.03120210082015

Mortality in septic shock is high in patients with compromised myocardial or renal function, and deterioration and death of such patients is frequently associated with progressive myocardial and renal failure.1 Hinshaw and his colleagues2,3 suggested that Escherichia coli endotoxin administration decreased renal blood flow, glomerular filtration, and tubular transport. More recently, Gillenwater et al,4 demonstrated that a direct renal vasoconstriction was produced by injection of endotoxin directly into the renal artery, and showed that this could largely be prevented by infusion of phentolamine hydrochloride into the renal artery. With regard to the heart, it has been shown experimentally that endotoxin has a depressant effect on myocardial contractility,5 and clinically, that there is a progressive decrease in the ventricular function relationships of patients in septic shock.6 The studies of Zweifach et al,7 and of Spink and his colleagues,8 have suggested that increased production of