Imidazole and indomethacin improve hepatic perfusion in sepsis.

Visceral microcirculatory insufficiency has been demonstrated in sepsis despite a hyperdynamic systemic circulation. This study examines the effect of the cyclo-oxygenase inhibitor indomethacin and the thromboxane synthetase inhibitor imidazole on septic hemodynamics and visceral perfusion in a septic rat model of cecal ligation and puncture. Animals received either indomethacin (INDO), imidazole (IMID), or saline intramuscularly at t = 0, 6, and 12 hr of peritonitis. Thermodilution cardiac output, mean arterial pressure, heart rate, hematocrit, effective hepatic blood flow, effective renal plasma flow, and arterial and mixed venous blood gases were determined at 15 hr. Both INDO and IMID improved effective hepatic blood flow in the septic animals to virtually sham, nonseptic levels without significantly altering systemic hemodynamics. This study suggests that the reduction in hepatic perfusion in sepsis may be mediated by thromboxane, the synthesis of which is suppressed by both INDO and IMID.