Protecting the gut and the liver in the critically ill: effects of dopexamine.
OBJECTIVE
To measure the clinical effects of dopexamine on systemic and splanchnic perfusion in critically ill patients.


METHODS
Prospective study.


METHODS
General intensive care unit.


METHODS
Ten patients with sepsis syndrome, acute respiratory failure, and at least one other organ system in failure. The median age of the patients was 62.5 yrs (range 29 to 78), and the median admission Acute Physiology and Chronic Health Evaluation (APACHE) II score was 24 points (range 14 to 38).


METHODS
Timed infusion of dopexamine to a maximum dose of 6 micrograms/kg/min.


RESULTS
Systemic hemodynamics and oxygen transport variables were obtained from measurements after arterial and pulmonary artery catheterization. Gastric intramucosal pH and hepatic blood flow/function measurements were made by tonometry and indocyanine green clearance, respectively. All measurements were made before dopexamine infusion, after 1 hr of dopexamine infusion, and again 1 hr after the infusion ended. Cardiac index increased with dopexamine from a baseline median of 4.0 L/min/m2 (range 1.2 to 5.5) to 4.8 L/min/m2 (range 1.5 to 8.03) (p < .01), and returned to its previous level 1 hr after the infusion ended (median 4.0 L/min/m2 [range 1.4 to 5.8], p < .01). During dopexamine infusion, gastric intramucosal pH improved significantly from a median baseline level of 7.21 (range 7.04 to 7.50) to 7.28 (range 7.13 to 7.46, p < .05). This improvement in gastric intramucosal pH was maintained (median 7.36 [range 7.13 to 7.46]) after the infusion ended. Indocyanine green half-life decreased but not significantly with dopexamine (medians before and during the infusion were 6.6 and 6.3 mins, respectively). Indocyanine green half-life increased significantly 1 hr after the infusion ended (median 7.4 mins [range 4.4 to 14.8], p < .05), and changes in cardiac index correlated with changes in indocyanine green half-life (Rs2 = 0.60, p < .001). Changes in gastric intramucosal pH were unrelated to all other measurements.


CONCLUSIONS
Dopexamine improves gastric intramucosal pH, and thus, splanchnic oxygenation. This improvement in gastric intramucosal pH appears to be independent of dopexamine's systemic effects.
Smithies
M
M
Department of Intensive Care, Guy's Hospital, London, UK.
Yee
T H
TH
Jackson
L
L
Beale
R
R
Bihari
D
D
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D016638:Critical Illness; D004298:Dopamine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D005745:Gastric Acidity Determination; D006439:Hemodynamics / Q000187:drug effects*; D017052:Hospital Mortality; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007208:Indocyanine Green / Q000493:pharmacokinetics; D007262:Infusions, Intravenous; D008102:Liver Circulation / Q000187:drug effects*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D010101:Oxygen Consumption / Q000187:drug effects; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D013152:Splanchnic Circulation / Q000187:drug effects*; D013577:Syndrome; D014665:Vasodilator Agents / Q000494:pharmacology* / Q000627:therapeutic use
D014665:Vasodilator Agents; C046318:dopexamine; D007208:Indocyanine Green; D004298:Dopamine