Effects of norepinephrine, epinephrine, and norepinephrine-dobutamine on systemic and gastric mucosal oxygenation in septic shock.
OBJECTIVE
To compare the effects of dopamine, norepinephrine, epinephrine, and the combination of norepinephrine and dobutamine on systemic and gastric mucosal oxygen metabolism in patients with septic shock.


METHODS
Sixteen patients with septic shock were enrolled in the present study. Each patient received dopamine firstly, then in a random succession epinephrine, norepinephrine, or norepinephrine-dobutamine, a mean systemic arterial pressure adjusted to >9.31 kPa. After 120 min of each treatment, hemodynamic, oxygen metabolic, and gastric mucosal parameters were obtained.


RESULTS
Epinephrine induced a significant increase in heart rate compared with other three groups (P <0.05), and a significant higher cardiac index compared with norepinephrine alone and norepinephrine-dobutamine (P <0.05). Oxygen extraction ratio values were lower with epinephrine infusion as compared with other three groups (P <0.05). Arterial lactate concentrations decreased significantly with norepinephrine-dobutamine as compared with dopamine and epinephrine infusions (P <0.05). As compared with epinephrine infusion, the gastric intramucosal pH values were higher with norepinephrine-dobutamine infusion (7.25+/-0.09 vs 7.14+/-0.07, P <0.05).


CONCLUSIONS
Dopamine, norepinephrine, epinephrine, or norepinephrine-dobutamine improved blood pressure. Epinephrine and dopamine had deleterious effect on oxygen metabolism, while norepinephrine plus low dose of dobutamine improved gastric mucosal perfusion and tissue oxygen utilization.
Zhou
Shao-Xia
SX
Department of Critical Care Medicine, Zhong-Da Hospital and School of Clinical Medicine, Southeast University, Nanjing 210009, China.
Qiu
Hai-Bo
HB
Huang
Ying-Zi
YZ
Yang
Yi
Y
Zheng
Rui-Qiang
RQ
D000316:Adrenergic alpha-Agonists / Q000494:pharmacology; D000318:Adrenergic beta-Agonists / Q000494:pharmacology; D000328:Adult; D002316:Cardiotonic Agents / Q000494:pharmacology; D004280:Dobutamine / Q000494:pharmacology*; D004298:Dopamine / Q000494:pharmacology*; D004837:Epinephrine / Q000494:pharmacology*; D005753:Gastric Mucosa / Q000378:metabolism; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D009638:Norepinephrine / Q000494:pharmacology*; D010101:Oxygen Consumption / Q000187:drug effects; D012772:Shock, Septic / Q000378:metabolism* / Q000503:physiopathology
D000316:Adrenergic alpha-Agonists; D000318:Adrenergic beta-Agonists; D002316:Cardiotonic Agents; D004280:Dobutamine; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine