Goal directed therapy with dobutamine in a porcine model of septic shock: effects on systemic and renal oxygen transport.
Systemic and renal haemodynamic and functional indices were measured in 15 anaesthetised pigs during systemic sepsis induced by faecal peritonitis. Five animals were assigned to maintenance of cardiac output (CO) at baseline, pre-infection values throughout the study (controls n = 5). In the remaining 10 animals, CO was increased by 25% prior to induction of sepsis and maintained at this level for the duration of the study using volume expansion with intravenous colloid and an infusion of either 20 micrograms/kg/min dobutamine (n = 5) or placebo (n = 5). Hourly measurements were made of CO, left renal blood flow, arterial and renal venous oxygen saturation, urine output, creatinine clearance and arterial partial pressure of oxygen until the animal died or until termination 8 h. Systemic indices of oxygen transport did not reflect the behaviour of the renal vascular bed during the management of sepsis. In the dobutamine group systemic oxygen uptake (VO2) increased from 173 +/- 30 to 277 +/- 73 ml/min (P less than 0.05), however this resulted in a decrease in renal DO2 (20 +/- 9 to 10 +/- 2 ml/min P less than 0.05) and there was no equivalent rise in renal VO2 (3.3 +/- 1.6 to 3.2 +/- 1.5 ml/min). There was however no significant difference in the effect on renal function of the three management protocols. Agents used to increase cardiac output during systemic sepsis may result in significantly different effects on the renal vascular bed which are not revealed by the measurement of systemic indices alone.
St George's Hospital Medical School, London, UK.
G A
GA
Haywood
D
D
Tighe
R
R
Moss
N
N
al-Saady
T O
TO
Foshola
S P
SP
Riley
I
I
Pearson
A
A
Webb
W J
WJ
McKenna
E D
ED
Bennett
D000818:Animals; D004280:Dobutamine / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D007668:Kidney / Q000378:metabolism*; D010100:Oxygen / Q000097:blood*; D010538:Peritonitis / Q000150:complications; D012079:Renal Circulation / Q000187:drug effects; D012772:Shock, Septic / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D013552:Swine
D004280:Dobutamine; D010100:Oxygen