Vasoactive drugs and the gut: is there anything new?
OBJECTIVE
Systemic changes in blood pressure and cardiac output induced by pressors and inotropes do not always correlate to improvements in regional perfusion. Since the gut is often referred to as the 'motor' of the systemic inflammatory response syndrome, the impact of vasoactive agents on splanchnic perfusion has theoretical importance. This review will highlight recent studies examining secondary effects of vasoactive agents on intestinal perfusion, metabolism, and barrier function.


RESULTS
Norepinephrine has minimal impact on mesenteric blood flow although the combination of norepinephrine and dobutamine increases splanchnic blood flow in sepsis. Dopamine also increases mesenteric blood flow although this may be associated with negative hepatic energy balance at high does. Vasopressin and epinephrine both have negative effects on splanchnic blood flow. Newer inodilators levosimendan and olprinone preferentially improve mesenteric perfusion in animal models.


CONCLUSIONS
Secondary effects of norepinephrine and dopamine on splanchnic perfusion are minor compared with their systemic effects. While vasopressin usage is increasing in the intensive care unit, caution should be used because of its adverse effects on gut perfusion. Experimental agents for the treatment of heart failure have beneficial gut-specific effects although the clinical significance of this is currently limited by their availability.
Woolsey
Cheryl A
CA
Department of Surgery, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Coopersmith
Craig M
CM
D000318:Adrenergic beta-Agonists / Q000494:pharmacology*; D000818:Animals; D004280:Dobutamine / Q000494:pharmacology*; D004347:Drug Interactions; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000187:drug effects; D009638:Norepinephrine / Q000494:pharmacology*; D018805:Sepsis / Q000188:drug therapy*; D013152:Splanchnic Circulation / Q000187:drug effects*; D014662:Vasoconstrictor Agents / Q000494:pharmacology*; D014667:Vasopressins / Q000494:pharmacology
D000318:Adrenergic beta-Agonists; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004280:Dobutamine; D009638:Norepinephrine