Am. J. Respir. Crit. Care Med.,
Volume 160, Number 3, September 1999, 839-845
A Dobutamine Test Can Disclose Hepatosplanchnic
Hypoperfusion in Septic Patients
JACQUES
CRETEUR,
DANIEL
DE BACKER,
and
JEAN-LOUIS
VINCENT
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Brussels, Belgium
In 36 hemodynamically stable septic patients, we explored whether changes in gastric mucosal-arterial PCO2 gradient (PCO2gap) induced by a short-term dobutamine infusion may reveal hepatosplanchnic hypoperfusion. Hepatosplanchnic blood flow (HSBF) was determined by the continuous indocyanine green infusion technique and gastric mucosal PCO2 (PgCO2) by saline tonometry. In each patient,
hemodynamic measurements, blood samples, and PgCO2 determinations were performed three
times: first at baseline (DOB 0), second during a dobutamine infusion at a dose of 5 µg/kg/min (DOB
5), and third at a dose of 10 µg/kg/min (DOB 10). The results were analyzed by Wilcoxon's matched-pairs signed rank test and are presented as medians with ranges. The PCO2gap decreased preferentially in groups of patients with inadequate hepatosplanchnic perfusion, i.e., with a low fractional HSBF (HSBF/CI), defined as the ratio of the HSBF to the simultaneous cardiac index, or a high gradient between the mixed venous blood and the suprahepatic blood O2 saturations (DSvhO2). In the 11 patients with a DSvhO2 above 20% at baseline, PCO2gap decreased from 12.1 (6.3 to 19.5) mm Hg at
DOB 0 to 6.2 (2.5 to 19.3) mm Hg at DOB 5 (p < 0.001 versus DOB 0), and to 4.2 (0.1 to 35.9) mm Hg
at DOB 10 (p < 0.05 versus DOB 5), whereas in the 25 patients with a DSvhO2 below 20% at baseline,
PCO2gap did not change significantly. At no time was the PCO2gap correlated with HSBF/CI or DSvhO2. We conclude that although the PCO2gap does not correlate well with global indexes of gut oxygenation, such a simple dobutamine infusion test could identify patients with inadequate hepatosplanchnic perfusion.
