Dobutamine compensates deleterious hemodynamic and metabolic effects of vasopressin in the splanchnic region in endotoxin shock.
BACKGROUND
Vasopressin is a potent vasopressor in septic shock, but it may impair splanchnic perfusion. We compared the effects of vasopressin alone and in combination with dobutamine on systemic and splanchnic circulation and metabolism in porcine endotoxin shock.


METHODS
Twelve pigs were randomized to receive either vasopressin (VASO, n = 6) or vasopressin in combination with dobutamine (DOBU, n = 6) during endotoxin shock (E. coli endotoxin infusion). Endotoxin infusion rate was increased to induce hypotension after which vasoactive drugs were started. We aimed to keep systemic mean arterial pressure (MAP) >70 mmHg by vasopressin; the goal of dobutamine infusion was to prevent decrease in cardiac output often associated with vasopressin infusion. Regional blood flows, oxygen delivery and consumption, arterial and regional lactate concentrations were measured.


RESULTS
Mean arterial pressure >70 mmHg was achieved in both the VASO and DOBU groups. After the primary decrease of cardiac output by vasopressin, systemic blood flow remained stable in vasopressin-treated animals. However, vasopressin as a monotherapy decreased portal venous blood flow. This was prevented by dobutamine. Vasopressin also induced splanchnic lactate release and arterial hyperlactatemia, which were not observed when dobutamine was combined with vasopressin.


CONCLUSIONS
Dobutamine prevents adverse hemodynamic and metabolic effects of vasopressin in septic shock.
Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Finland.
T J
TJ
Martikainen
A
A
Uusaro
J J
JJ
Tenhunen
E
E
Ruokonen
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000818:Animals; D001784:Blood Gas Analysis; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D004280:Dobutamine / Q000627:therapeutic use*; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects*; D006490:Hemostatics / Q000009:adverse effects* / Q000627:therapeutic use*; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D019344:Lactic Acid / Q000097:blood; D017551:Microdialysis; D019289:Pyruvic Acid / Q000097:blood; D012039:Regional Blood Flow / Q000187:drug effects; D012772:Shock, Septic / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D013152:Splanchnic Circulation / Q000187:drug effects* / Q000502:physiology; D013552:Swine; D014667:Vasopressins / Q000009:adverse effects* / Q000627:therapeutic use*
D000318:Adrenergic beta-Agonists; D006490:Hemostatics; D014667:Vasopressins; D019344:Lactic Acid; D004280:Dobutamine; D019289:Pyruvic Acid