H Zhang, N Smail, A Cabral, P Rogiers and JL Vincent
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.

We explored the effects of norepinephrine on blood flow distribution and oxygen extraction capabilities during hyperdynamic endotoxic shock. Twelve anesthetized and mechanically ventilated dogs received 2 mg/kg of Escherichia coli endotoxin followed by a general saline infusion and were then randomly divided into two groups: six received norepinephrine (1 microg/kg/min), and six served as control subjects. The norepinephrine group maintained higher mean arterial pressure, cardiac index, left ventricular stroke work index, and hepatic arterial blood flow without altering blood flow to portal, mesenteric, and renal beds. When cardiac tamponade was induced to study tissue oxygen extraction capabilities, the norepinephrine group had a lower critical oxygen delivery in whole body (11.5 +/- 5.2 versus 14.3 +/- 1.4 ml/kg/min, p < 0.05) and in liver (25.0 +/- 11.3 versus 38.0 +/- 9.0 ml/min, p = NS) and a higher critical oxygen extraction ratio in whole body (53.8 +/- 17.7 versus 32.0 +/- 6.1%, p < 0.05), and in liver (57.0 +/- 11.9 versus 35.2 +/- 4.3%, p < 0.05). We conclude that during endotoxic shock in dogs, norepinephrine hardly influences blood flow distribution and could even increase hepatic artery blood flow, and it can also improve whole body and liver oxygen extraction capabilities.

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