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


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.


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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.


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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).

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