Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: Which is best?

被引:232
作者
De Backer, D [1 ]
Creteur, J [1 ]
Silva, E [1 ]
Vincent, JL [1 ]
机构
[1] Free Univ Brussels, Erasme Univ Hosp, Dept Intens Care, B-1070 Brussels, Belgium
关键词
cardiac output; splanchnic blood flow; tonometry; hepatic vein oxygen saturation; adrenergic agents; lactate;
D O I
10.1097/01.CCM.0000063045.77339.B6
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To assess the effects of different doses of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in patients with septic shock. Design. Prospective, randomized, open-label study. Setting. A 31-bed, medicosurgical intensive care unit of a university hospital. Patients: Convenience sample of 20 patients with septic shock, separated into two groups according to whether (moderate shock group, n = 10) or not (severe shock, n = 10) dopamine alone was able maintain mean arterial pressure >65 mm Hg. Interventions. Dopamine was progressively withdrawn and replaced successively by norepinephrine and then epinephrine (the order of the two agents was randomly determined) to maintain mean arterial pressure constant (moderate shock) or to increase mean arterial pressure above 65 mm Hg (severe shock). Measurements and Main Results. Systemic circulation (pulmonary artery catheter) and splanchnic circulation (indocyanine green dilution and hepatic vein catheter) and gastric mucosal Pco(2) (gas tonometry) were measured during dopamine (moderate shock only), norepinephrine, and epinephrine administration (both groups). Data were analyzed with nonparametric tests and are presented as median [percentiles 25-75]. In moderate shock, cardiac index was similar to dopamine and norepinephrine (3.1 [2.7-3.8] vs. 2.9 [2.7-4.1] L/min.m(2), p = nonsignificant) but greater with epinephrine (4.1 [3.5-4.4] p < .01 vs. dopamine and norepinephrine). Splanchnic blood flow was similar with the three agents (732 [413-1483] vs. 746 [470-1401] vs. 653 [476-1832] mL/min.m(2), p = nonsignificant). The gradient between mixed-venous and hepatic venous oxygen saturations was lower with dopamine than with norepinephrine and epinephrine, but the Pco(2) gap was similar with the three agents. In severe shock, cardiac index was higher, but splanchnic blood flow was lower, with epinephrine than with norepinephrine (4.6 [3.7-5.3] vs. 3.4 [3.0-4.1] L/min.m(2), p < .01 and 860 [684-1334] vs. 977 [806-1802] mL/min.m(2), p <.05, respectively). Epinephrine increased the mixed-venous and hepatic venous oxygen saturation gradient but did not alter Pco(2) gap. Conclusions. Dopamine and norepinephrine have similar hemodynamic effects, but epinephrine can impair splanchnic circulation in severe septic shock.
引用
收藏
页码:1659 / 1667
页数:9
相关论文
共 35 条
  • [1] DOBUTAMINE INFUSIONS IN STABLE, CRITICALLY ILL CHILDREN - PHARMACOKINETICS AND HEMODYNAMIC ACTIONS
    BERG, RA
    DONNERSTEIN, RL
    PADBURY, JF
    [J]. CRITICAL CARE MEDICINE, 1993, 21 (05) : 678 - 686
  • [2] BERSTEN AD, 1992, SURGERY, V112, P549
  • [3] SPLANCHNIC BLOOD-FLOW IN MAN - EVIDENCE FOR MEDIATION VIA A BETA-ADRENERGIC MECHANISM
    BRAATVEDT, GD
    FLYNN, MD
    STANNERS, A
    HALLIWELL, M
    CORRALL, RJM
    [J]. CLINICAL SCIENCE, 1993, 84 (02) : 201 - 207
  • [4] EFFECT OF VASOPRESSORS ON ORGAN BLOOD-FLOW DURING ENDOTOXIN-SHOCK IN PIGS
    BRESLOW, MJ
    MILLER, CF
    PARKER, SD
    WALMAN, AT
    TRAYSTMAN, RJ
    [J]. AMERICAN JOURNAL OF PHYSIOLOGY, 1987, 252 (02): : H291 - H300
  • [5] Monitoring gastric mucosal carbon dioxide pressure using gas tonometry: In vitro and in vivo validation studies
    Creteur, J
    DeBacker, D
    Vincent, JL
    [J]. ANESTHESIOLOGY, 1997, 87 (03) : 504 - 510
  • [6] Does hepato-splanchnic Vo2/Do2 dependency exist in critically ill septic patients?
    De Backer, D
    Creteur, J
    Noordally, O
    Smail, N
    Gulbis, B
    Vincent, JL
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1998, 157 (04) : 1219 - 1225
  • [7] Lactate production by the lungs in acute lung injury
    DeBacker, D
    Creteur, J
    Zhang, HB
    Norrenberg, M
    Vincent, JL
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1997, 156 (04) : 1099 - 1104
  • [8] Effects of epinephrine, norepinephrine, or the combination of norepinephrine and dobutamine on gastric mucosa in septic shock
    Duranteau, J
    Sitbon, P
    Teboul, JL
    Vicaut, E
    Anguel, N
    Richard, C
    Samii, K
    [J]. CRITICAL CARE MEDICINE, 1999, 27 (05) : 893 - 900
  • [9] ARE THE EFFECTS OF NORADRENALINE, ADRENALINE AND DOPAMINE INFUSIONS ON VO2 AND METABOLISM TRANSIENT
    ENSINGER, H
    WEICHEL, T
    LINDNER, KH
    GRUNERT, A
    GEORGIEFF, M
    [J]. INTENSIVE CARE MEDICINE, 1995, 21 (01) : 50 - 56
  • [10] COMBINED MEASUREMENTS OF BLOOD LACTATE CONCENTRATIONS AND GASTRIC INTRAMUCOSAL PH IN PATIENTS WITH SEVERE SEPSIS
    FRIEDMAN, G
    BERLOT, G
    KAHN, RJ
    VINCENT, JL
    [J]. CRITICAL CARE MEDICINE, 1995, 23 (07) : 1184 - 1193