Dopexamine increases splanchnic blood flow but decreases gastric mucosal pH in severe septic patients treated with dobutamine.
OBJECTIVE
To assess the effects of dopexamine on splanchnic blood flow and splanchnic oxygen uptake in septic patients.


METHODS
A prospective, controlled trial.


METHODS
A ten-bed intensive care unit (ICU) in a university hospital.


METHODS
Twelve patients with severe sepsis (according to the criteria of the 1992 American College of Chest Physicians/Society of Critical Care Medicine consensus conference) being stabilized by volume loading and treated to an elevated oxygen delivery by dobutamine infusion.


METHODS
Infusion of increasing dosages of dopexamine (0.5, 1.0, 2.0, and 4.0 microg/kg/min).


RESULTS
Systemic and splanchnic hemodynamic and oxygen transport parameters as well as gastric mucosal pH (pHi) were measured. A hepatic venous catheter technique with indocyanine green dye dilution was used to determine splanchnic blood flow. Dopexamine increased global and splanchnic oxygen delivery without affecting oxygen consumption (VO2). Splanchnic blood flow increased proportionally to cardiac output, indicating that there was no selective effect of dopexamine on the splanchnic flow. Dopexamine decreased pHi in a dose-dependent fashion in all 12 patients.


CONCLUSIONS
In hemodynamically stable, hyperdynamic septic patients being treated with dobutamine, dopexamine has no selective effect on splanchnic blood flow. In fact, a decreased pHi suggests a harmful effect on gastric mucosal perfusion.
Meier-Hellmann
A
A
Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University, Jena, Germany.
Bredle
D L
DL
Specht
M
M
Hannemann
L
L
Reinhart
K
K
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004280:Dobutamine / Q000008:administration & dosage / Q000627:therapeutic use*; D004298:Dopamine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018491:Dopamine Agonists / Q000008:administration & dosage*; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply / Q000187:drug effects*; D006785:Hospitals, University; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D010101:Oxygen Consumption; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D013152:Splanchnic Circulation / Q000187:drug effects*; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D018491:Dopamine Agonists; C046318:dopexamine; D004280:Dobutamine; D004298:Dopamine