Skip to main content

Effect of dopexamine on CO2 -gradients and splanchnic energy balance in septic shock

Objective

Septic shock is characterized by enhanced hepato-splanchnic blood flow resulting from increased metabolic activity. This hypermetabolism may lead to mismatch of regional O2 supply and demand reflected by increased CO2-gradients and lactate/pyruvate ratios. In patients after cardiac surgery dopexamine is known to increase splanchnic perfusion. Therefore, we studied the effect of dopexamine on regional CO2-gradients and energy balance in patients with septic shock.

Patients and methods

Twelve patients with septic shock were studied. Cardiac index (CI) was ≥ 3 l/min/m2 and noradrenaline ≥ 0.04 μg/kg×min-1 was infused to maintain mean arterial pressure (MAP) ≥ 60 mmHg. In addition to routine systemic hemodynamics and gas exchange we inserted a Swan Ganz catheter into a hepatic vein to measure splanchnic blood flow (Qspl) using primed continous infusion of indocyanine green (ICG) dye. Moreover, we assessed splanchnic lactate uptake (Fick principle), hepatic venous lactate/pyruvate ratio as well as PCO2 (PCO2hv), splanchnic O2 delivery (DO2spl) and consumption (VO2spl). The gatric mucosal PCO2 (PCO2gm) was determined via a nasogastric tube. Measurements were done before, during and after dopexamine infusion. Data were obtained after 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 unpredictable changes in the metabolic state and regional PCO2 gradients after a dopexamine-induced increase in DO2spl, underscores the independent response of hepato-splanchnic perfusion and metabolism to therapeutic interventions.

Table

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kiefer, P., Tugtekin, I., Putzke, M. et al. Effect of dopexamine on CO2 -gradients and splanchnic energy balance in septic shock. Crit Care 3 (Suppl 1), P159 (2000). https://doi.org/10.1186/cc532

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/cc532

Keywords

  • Septic Shock
  • Mean Arterial Pressure
  • Cardiac Index
  • Indocyanine Green
  • Dopexamine