Effect of a dopexamine-induced increase in cardiac index on splanchnic hemodynamics in septic shock.

Abstract

In 12 patients with hyperdynamic septic shock we studied the effect of dopexamine, a combined dopamine and beta-adrenergic agonist, on hepatosplanchnic hemodynamics and O(2) exchange. All patients required noradrenaline to maintain mean arterial pressure > 60 mm Hg (noradrenaline >/= 0.04 microg x kg(-1) x min(-1)) with a cardiac index >/= 3.0 L/min/m(2). Splanchnic blood flow (Qspl) 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 CO(2) 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 microg x kg(-1) x min(-1)) 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 After 90 min all measurements were repeated, and dopexamine was withdrawn followed by a third measurement.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 Qspl (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 Qspl to total blood flow decreased (21/28-13 versus 19/28-12%, p < 0.05). Although both global and regional oxygen delivery (DO(2)) consistently increased, neither global or regional V O(2) nor PCO(2) gradients were significantly affected. In patients with septic shock and ongoing noradrenaline treatment dopexamine seems to have no preferential effects on hepatosplanchnic hemodynamics, O(2) exchange, or energy balance.

• Authors: P Kiefer, I Tugtekin, H Wiedeck, H Bracht, G Geldner, M Georgieff, P Radermacher
• Journal: American journal of respiratory and critical care medicine (Am J Respir Crit Care Med) Vol. 161 Issue 3 Pt 1 Pg. 775-9 (Mar 2000) ISSN: 1073-449X [Print] United States
• PMID: 10712321 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Dopamine Agonists
• dopexamine
• Dopamine

Topics

• Cardiac Output (drug effects, physiology)
• Dopamine (adverse effects, analogs & derivatives, therapeutic use)
• Dopamine Agonists (adverse effects, therapeutic use)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Energy Metabolism (drug effects, physiology)
• Gastric Mucosa (blood supply)
• Hemodynamics (drug effects, physiology)
• Humans
• Infusions, Intravenous
• Oxygen Consumption (drug effects, physiology)
• Pulmonary Gas Exchange (drug effects, physiology)
• Shock, Septic (drug therapy, physiopathology)
• Splanchnic Circulation (drug effects, physiology)