title: Effect of a dopexamine-induced increase in cardiac index on splanchnic hemodynamics in septic shock.
abstract: In 12 patients with hyperdynamic septic shock we studied the effect of dopexamine, a combined dopamine and beta-adrenergic agonist, on hepatosplanchnic hemodynamics and O(2) exchange. All patients required noradrenaline to maintain mean arterial pressure > 60 mm Hg (noradrenaline >/= 0.04 microg x kg(-1) x min(-1)) with a cardiac index >/= 3.0 L/min/m(2). Splanchnic blood flow (Qspl) was measured using primed continuous infusion of indocyanine green dye with hepatic venous sampling. In addition tonometric gastric mucosal-arterial and gastric mucosal-hepatic venous P CO(2) gradients were assessed as indicators of regional energy balance. After 90 min of stable hemodynamics a first measurement was obtained. Then dopexamine infusion was titrated (1-4 microg x kg(-1) x min(-1)) to increase cardiac output by approximately 25% (20-30%). After 90 min all measurements were repeated, and dopexamine was withdrawn followed by a third measurement. Median Qspl (0.86/1.23-0. 66 versus 0.96/1.42-0.85 L/min/m (2) [median value/25th-75th percentiles], p < 0.05) increased whereas the fractional contribution of Qspl to total blood flow decreased (21/28-13 versus 19/28-12%, p < 0.05). Although both global and regional oxygen delivery (DO(2)) consistently increased, neither global or regional V O(2) nor PCO(2) gradients were significantly affected. In patients with septic shock and ongoing noradrenaline treatment dopexamine seems to have no preferential effects on hepatosplanchnic hemodynamics, O(2) exchange, or energy balance.
authors.affiliation: Department of Anesthesiology, University Clinic Ulm, Ulm, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Kiefer
authors.forename: I
authors.initials: I
authors.lastname: Tugtekin
authors.forename: H
authors.initials: H
authors.lastname: Wiedeck
authors.forename: H
authors.initials: H
authors.lastname: Bracht
authors.forename: G
authors.initials: G
authors.lastname: Geldner
authors.forename: M
authors.initials: M
authors.lastname: Georgieff
authors.forename: P
authors.initials: P
authors.lastname: Radermacher
mesh_terms: D002302:Cardiac Output / Q000187:drug effects* / Q000502:physiology; D004298:Dopamine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004734:Energy Metabolism / Q000187:drug effects / Q000502:physiology; D005753:Gastric Mucosa / Q000098:blood supply; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D010101:Oxygen Consumption / Q000187:drug effects / Q000502:physiology; D011659:Pulmonary Gas Exchange / Q000187:drug effects / Q000502:physiology; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology; D013152:Splanchnic Circulation / Q000187:drug effects* / Q000502:physiology
chemical_list: D018491:Dopamine Agonists; C046318:dopexamine; D004298:Dopamine