Effects of short-term fenoldopam infusion on gastric mucosal blood flow in septic shock.
BACKGROUND
Inadequate splanchnic perfusion in septic shock is associated with increased morbidity and mortality. As result of splanchnic ischemia, mucosal permeability increases. Considering the implication of improved mucosal perfusion in terms of maintenance of mucosal barrier integrity, dopamine-1 receptor stimulation could be helpful in septic shock. The goal of the current study was to determine the effects of fenoldopam on systemic hemodynamic parameters and gastric mucosal perfusion in patients with septic shock. Furthermore, the authors tested the hypothesis that the addition of fenoldopam (0.1 microg x kg(-1) x min(-1)) to a combination of norepinephrine and dobutamine (5 microg x kg(-1) x min(-1)) may improve gastric mucosal perfusion in septic shock.


METHODS
Patients with septic shock were randomized to a double-blind 2-h infusion of fenoldopam (n = 20) or placebo (n = 20). Each group received dobutamine (5 microg x kg(-1) x min(-1)), and the dosage of norepinephrine was adjusted to achieve a mean arterial pressure between 70 and 80 mmHg. A laser-Doppler probe and tonometer were introduced into the gastric lumen.


RESULTS
A significant increase in gastric mucosal perfusion, detected by laser-Doppler flowmetry, was observed in the group treated with fenoldopam (P < 0.05). In addition, this increase in microcirculatory flow occurred despite the fact that systemic flow remained unchanged. Differences in gastroarterial partial pressure of carbon dioxide values were not statistically significant in the fenoldopam and placebo groups.


CONCLUSIONS
The study showed that, for the same mean arterial pressure, short-term fenoldopam infusion increased gastric mucosal perfusion in patients with septic shock.
Morelli
Andrea
A
Department of Anesthesiology and Intensive Care, University of Rome La Sapienza, Rome, Italy. andrea.morelli@uniroma1.it
Rocco
Monica
M
Conti
Giorgio
G
Orecchioni
Alessandra
A
De Gaetano
Andrea
A
Coluzzi
Flaminia
F
Vernaglione
Enrico
E
Pelaia
Paolo
P
Pietropaoli
Paolo
P
D000318:Adrenergic beta-Agonists / Q000494:pharmacology; D003422:Critical Care; D004280:Dobutamine / Q000494:pharmacology; D004311:Double-Blind Method; D005260:Female; D018818:Fenoldopam / Q000008:administration & dosage / Q000494:pharmacology*; D005745:Gastric Acidity Determination; D005753:Gastric Mucosa / Q000098:blood supply* / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000494:pharmacology; D010101:Oxygen Consumption / Q000502:physiology; D012039:Regional Blood Flow / Q000187:drug effects; D012772:Shock, Septic / Q000503:physiopathology*; D014662:Vasoconstrictor Agents / Q000494:pharmacology; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology*
D000318:Adrenergic beta-Agonists; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D004280:Dobutamine; D018818:Fenoldopam; D009638:Norepinephrine