Volume 4 Supplement 1

20th International Symposium on Intensive Care and Emergency Medicine

Open Access

Influence of enoximone and dobutamine upon liver perfusion and function in fluid optimized septic patients

  • H Kern1,
  • T Schröder1,
  • M Kaulfuss1,
  • WJ Kox1 and
  • C Spies1
Critical Care20004(Suppl 1):P44

https://doi.org/10.1186/cc764

Published: 21 March 2000

Full text

Introduction

Splanchnic mucosal perfusion abnormalities have been implicated in the development of sepsis and multiple organ failure. In clinical and experimental settings, administration of dobutamine can increase hepatosplanchnic perfusion [1,2]. The administration of enoximone during and after cardiopulmonary bypass diminished endotoxin levels in liver venous blood indicating a beneficial effect on tissue perfusion and barrier function of the gut [3]. The aim of this study was to investigate the impact of dobutamine and enoximone upon liver perfusion and function in fluid optimized septic patients.

Methods

After approval by the local ethical committee and obtained written informed consent by next of kin, 48 septic patients were included in this study. After fluid resuscitation according to an optimal left atrial filling pressure established by plotting left ventricular stroke work index against pulmonary artery occlusion pressure, patients were randomly treated with dobutamine (initially 5 μg/kg/min, increasing dose up to a maximum of 20 μg/kg/min) or enoximone (initially 2.5 μg/kg/min, increasing dose up to a maximum of 10 μg/kg/min) for 10h up to a dosage where no further increase in left ventricular stroke work index was achieved. Hemodynamics, liver blood flow (LBF), hepatic tumor necrosis factor (TNF) and monoethylglycinexylidide (MEGX) kinetics to assess hepatic function were performed within the first 12 h of sepsis, before administration of inotropic support as well as 12 h and 48 h after treatment. Statistical analysis was performed using Wilcoxon signed rank sum and Friedman test.

Results

Basic patient characteristics (age, sex, APACHE III) did not differ between groups. Oxygen delivery and oxygen consumption increased in both groups without significant difference between groups.

Conclusion

Administration of enoximone in fluid optimized septic patients may be favorable in comparison to dobutamine. Enhanced DO2 and VO2 in both regimens resulted in an increased regional perfusion and improved splanchnic function only in the enoximone group indicated by a diminished release of the pro-inflammatory hepatic TNF and increased MEGX.
 

Enoximone

Dobutamine

 

Baseline

12 h treatment

48 h treatment

Baseline

12 h treatment

48 h treatment

LBF [L/min/m²]

2.9± 0.7

3.3± 0.8 b

3.2± 0.7 b

2.8± 1.0

3.0± 0.8 b

2.9± 0.8 b

LTNF [pg/mL]

32± 26

43± 31 ab

37± 32

29± 28

62± 36 ab

29± 26

MEGX [μg/L]

19± 19

33± 26 ab

29± 20 b

22± 16

21± 22 a

32± 17 b

Results are presented as means ± standard deviation; a) P<0.05 between groups; b) P<0.05 within groups compared to baseline.

Authors’ Affiliations

(1)
Department of Anesthesiology and Intensive Care Medicine, University Hospital Charité (Campus Mitte), Humboldt-University Berlin

References

  1. J Surg Res 65: 93-100. 10.1006/jsre.1996.0349Google Scholar
  2. Am J Resp Crit Care Med 160: 839-845.Google Scholar
  3. Intensive Care Med 23: 267-275. 10.1007/s001340050327Google Scholar

Copyright

© Current Science Ltd 2000

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