Effect of a dopexamine induced increase in cardiac output on splanchnic hemodynamics in septic shock

Objective

In patients after cardiac surgery dopexamine is known to increase both global and hepato splanchnic blood flow. Sepsis per se and the infusion of noradrenaline may alter the response to the onset of dopexamine. Therefore we determined the changes in global and regional hemodynamics in patients with septic shock.

Patients/methods

Twelve patients with septic shock were studied. All patients had a cardiac index (CI) ≥ 3 l/min/m² and needed noradrenaline ≥ 0.04 μg/kg×min^-1 to maintain mean arterial pressure (MAP ≥ 60 mmHg). In addition to routine systemic hemodynamics and gas exchange we inserted a balloon-tipped Swan Ganz catheter into a hepatic vein to determine splanchnic blood flow (Qspl), hepatic venous pressure (HVP) and the hepatic venous occlusion pressure (HVOP) as an estimate of portal venous pressure. Splanchnic blood flow was measured using the steady-state indocyanine green (ICG) infusion technique. Measurements were done before, during and after dopexamine infusion. Data were always obtained after at least 90 min of hemodynamic steady-state. Dopexamine was titrated (1-4 μg/kg×min^-1) to obtain a 30% increase in CI.

Results

See Table.

Conclusion

The dopexamine induced increase in Qspl paralleled that of CI. A preferential effect on splanchnic circulation could not be detected. The increase in Qspl was due to a decreased prehepatic resistance.

Table