Splanchnic blood flow is greater in septic shock treated with norepinephrine than in severe sepsis.
OBJECTIVE
To assess global and splanchnic blood flow and oxygen transport in patients with sepsis with and without norepinephrine treatment.


METHODS
Prospective, clinical study.


METHODS
University hospital intensive care unit.


METHODS
A convenience sample of 15 septic shock patients treated with norepinephrine and 13 patients with severe sepsis who did not receive norepinephrine.


RESULTS
There were no differences between the two groups in global haemodynamics and oxygen transport. Splanchnic blood flow and oxygen delivery (splanchnic DO2 303 +/- 43 ml/min per m2) and consumption (splanchnic VO2 100 +/- 13 ml/min per m2) were much higher in the septic shock group compared with the severe sepsis group (splanchnic DO2 175 +/- 19 ml/min per m2, splanchnic VO2 61 +/- 6 ml/min per m2). Gastric mucosal pH was subnormal in both groups (septic shock 7.29 +/- 0.02, severe sepsis 7.25 +/- 0.02) with no significant difference. No significant differences between groups were detected in lactate values.


CONCLUSIONS
These data confirm a redistribution of blood flow to the splanchnic region in sepsis that is even more pronounced in patients with septic shock requiring norepinephrine. However, subnormal gastric mucosal pH suggested inadequate oxygenation in parts of the splanchnic region due to factors other than splanchnic hypoperfusion. Progress in this area will depend on techniques that address not only total splanchnic blood flow, but also inter-organ flow distribution, intra-organ distribution, and other microcirculatory or metabolic malfunctions.
Meier-Hellmann
A
A
Department of Anesthesia and Critical Care Medicine, Friedrich Schiller University Jena, Germany.
Specht
M
M
Hannemann
L
L
Hassel
H
H
Bredle
D L
DL
Reinhart
K
K
D018806:APACHE; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D010101:Oxygen Consumption / Q000187:drug effects; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000503:physiopathology; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology; D013152:Splanchnic Circulation / Q000187:drug effects*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D009638:Norepinephrine