The effect of dobutamine infusion on splanchnic blood flow and oxygen transport in patients with acute pancreatitis.
OBJECTIVE
To measure the blood flow distribution and oxygen transport in pancreatitis and to evaluate the regional effects of increased systemic blood flow.


METHODS
Nonrandomized controlled trial.


METHODS
A general intensive care unit in a tertiary care center.


METHODS
10 patients with pancreatitis requiring mechanical ventilation were studied after fluid resuscitation, and for the response to dobutamine, the patients served as their own controls. For the baseline, 11 patients scheduled for elective abdominal surgery served as a control group.


METHODS
Systemic and regional hemodynamics were measured after fluid resuscitation to predefined hemodynamic endpoints. In patients with pancreatitis, the measurement was repeated after cardiac output had been increased by at least 25% by dobutamine.


RESULTS
Hepatosplanchnic blood flow was estimated using regional catheterization and the dye dilution method. In patients with pancreatitis, the cardiac index did not differ from that of the control group (3.9 +/- 0.8 vs 4.1 +/- 0.71.min-1.m-2;NS). Accordingly, there was no difference in the splanchnic blood flow (1.1 +/- 0.4 vs 1.2 +/- 0.51.min-1.m-2;NS). Systemic and splanchnic oxygen consumption was increased in patients with pancreatitis (179 +/- 25 vs 147 +/- 27 ml.min-1.m-2, p < 0.05 and 68 +/- 15 vs 49 +/- 19 ml.min-1.m-2, p < 0.05), and systemic and splanchnic oxygen extraction was higher (0.34 +/- 0.08 vs 23 +/- 0.05, p < 0.01 and 0.46 +/- 0.18 vs 0.28 +/- 0.08, p < 0.05, respectively). Dobutamine had inconsistent effects on splanchnic blood flow: in individual patients, splanchnic blood flow even decreased substantially.


CONCLUSIONS
In severe pancreatitis, oxygen consumption is increased in the splanchnic region; increased splanchnic oxygen demand is not always met by adequately increased blood flow. Increasing the systemic blood flow with dobutamine does not improve perfusion in the splanchnic bed.
Ruokonen
E
E
Department of Intensive Care, Kuopio University Hospital, Finland.
Uusaro
A
A
Alhava
E
E
Takala
J
J
D000208:Acute Disease; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D004280:Dobutamine / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects*; D010195:Pancreatitis / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery; D013152:Splanchnic Circulation / Q000187:drug effects*
D002316:Cardiotonic Agents; D004280:Dobutamine