Am. J. Respir. Crit. Care Med., Volume 161, Number 3, March 2000, 775-779

Effect of a Dopexamine-induced Increase in Cardiac Index on Splanchnic Hemodynamics in Septic Shock

PETER KIEFER, ILYAS TUGTEKIN, HEIDE WIEDECK, HENDRIK BRACHT, GÖTZ GELDNER, MICHAEL GEORGIEFF, and PETER RADERMACHER

Department of Anesthesiology, University Clinic Ulm, Ulm, Germany

In 12 patients with hyperdynamic septic shock we studied the effect of dopexamine, a combined dopamine and -adrenergic agonist, on hepatosplanchnic hemodynamics and O₂ exchange. All patients required noradrenaline to maintain mean arterial pressure > 60 mm Hg (noradrenaline  0.04 µg · kg¹ · min¹) with a cardiac index  3.0 L/min/m². Splanchnic blood flow (spl) was measured using primed continuous infusion of indocyanine green dye with hepatic venous sampling. In addition tonometric gastric mucosal-arterial and gastric mucosal-hepatic venous P CO₂ gradients were assessed as indicators of regional energy balance. After 90 min of stable hemodynamics a first measurement was obtained. Then dopexamine infusion was titrated (1-4 µg · kg¹ · min¹) to increase cardiac output by approximately 25% (20-30%). After 90 min all measurements were repeated, and dopexamine was withdrawn followed by a third measurement. Median spl (0.86/1.23-0.66 versus 0.96/1.42-0.85 L/min/m ² [median value/25th-75th percentiles], p < 0.05) increased whereas the fractional contribution of spl to total blood flow decreased (21/28-13 versus 19/28-12%, p < 0.05). Although both global and regional oxygen delivery (DO₂) consistently increased, neither global or regional O₂ nor PCO₂ gradients were significantly affected. In patients with septic shock and ongoing noradrenaline treatment dopexamine seems to have no preferential effects on hepatosplanchnic hemodynamics, O₂ exchange, or energy balance. Kiefer P, Tugtekin I, Wiedeck H, Bracht H, Geldner G, Georgieff M, Radermacher P. Effect of a dopexamine-induced increase in cardiac index on splanchnic hemodynamics in septic shock.

This article has been cited by other articles:

				M. C. Renton and C. P. Snowden Dopexamine and its role in the protection of hepatosplanchnic and renal perfusion in high-risk surgical and critically ill patients Br. J. Anaesth., April 1, 2005; 94(4): 459 - 467. [Abstract] [Full Text] [PDF]

				J. J. Tenhunen, T. J. Martikainen, A. Uusaro, and E. Ruokonen Dopexamine reverses colonic but not gastric mucosal perfusion defects in lethal endotoxin shock Br. J. Anaesth., December 1, 2003; 91(6): 878 - 885. [Abstract] [Full Text] [PDF]

				M. I. Rudis and C. Chant Update on Vasopressors and Inotropes in Septic Shock Journal of Pharmacy Practice, April 1, 2002; 15(2): 124 - 134. [Abstract] [PDF]

				M. J. TOBIN Critical Care Medicine in AJRCCM 2000 Am. J. Respir. Crit. Care Med., October 15, 2001; 164(8): 1347 - 1361. [Full Text] [PDF]

				M. Jendbro, C.-J. Johansson, P. Strandberg, H. Falk-Nilsson, and S. Edsbäcker Pharmacokinetics of Budesonide and Its Major Ester Metabolite after Inhalation and Intravenous Administration of Budesonide in the Rat Drug Metab. Dispos., April 13, 2001; 29(5): 769 - 776. [Abstract] [Full Text]