Effects of catecholamines on regional perfusion and oxygenation in critically ill patients.
Multiple organ failure is the major cause of death in patients with sepsis. Bacterial translocation from the gut is considered to induce and maintain sepsis. Therefore, the splanchnic region plays an important role in the pathogenesis and treatment of sepsis. There is evidence for a very high risk of imbalance between oxygen delivery and oxygen consumption especially in the splanchnic region. Consequently, there is a crucial interest whether it is possible to influence the splanchnic perfusion by specific catecholamines. Unfortunately, only a few, conflicting studies have looked at the effects of the various catecholamines on regional blood flow. Therefore, a clear recommendation for a specific catecholamine regimen in septic shock is impossible. Furthermore, it is unknown whether the choice of a specific catecholamine in the treatment of septic shock affects the patient's outcome. In most patients, the use of vasopressors is indispensable because adequate haemodynamic perfusion pressure is not achieved with fluid therapy alone. The negative effects of vasopressors on splanchnic perfusion are known from studies carried out under non septic conditions. Norepinephrine and dopamine in doses of 10 micrograms/kg/min in septic animals are without negative effects on splanchnic perfusion. Preliminary results show Preliminary results show a decrease in splanchnic oxygenation in patients with septic shock treated with epinephrine. Catecholamines with beta mimetic effects are often used to increase DO2. The question as to whether dobutamine or dopamine should be used first in treatment of septic shock cannot be answered yet. Whether treatment with low dose dopamine or dopexamine actually improves renal function and splanchnic oxygenation is the purpose of ongoing studies.
Meier-Hellmann
A
A
Dept. of Anesthesia and Critical Care Medicine, Friedrich Schiller University Jena, Germany.
Reinhart
K
K
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D001424:Bacterial Infections / Q000503:physiopathology; D018988:Bacterial Translocation; D002395:Catecholamines / Q000627:therapeutic use*; D016638:Critical Illness; D006801:Humans; D009102:Multiple Organ Failure / Q000503:physiopathology; D010101:Oxygen Consumption / Q000187:drug effects*; D012772:Shock, Septic / Q000188:drug therapy; D013152:Splanchnic Circulation / Q000187:drug effects*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
D000318:Adrenergic beta-Agonists; D002395:Catecholamines; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents