Volume 1 Supplement 1

17th International Symposium on Intensive Care and Emergency Medicine

Open Access

Is β-adrenergic receptor stimulation crucial for splanchnic O2availability in septic shock?

  • H Reinelt1,
  • P Kiefer1,
  • G Fischer1,
  • J Vogt1,
  • M Weiss1,
  • U Wachter1,
  • M Georgieff1 and
  • P Radermacher1
Critical Care19971(Suppl 1):P080

https://doi.org/10.1186/cc71

Published: 1 March 1997

Background

Septic shock is characterized by arterial hypotension despite adequate fluid resuscitation, and treatment with vasopressors is current practice [1]. Vasopressors, however, may impair capillary exchange capacity in the splanchnic region [2]. Therefore we tested the effect of replacing noradrenaline (NOR) by phenylephrine (PHE) on splanchnic hemodynamics and O2 kinetics in septic shock.

Methods

In up to now four patients with hyperdynamic septic shock (CI ≥ 41/min/m2) all requiring NOR (0.25 ± 0.22 μg/kg min) to maintain mean arterial pressure NOR was replaced by PHE (4.2 ± 3.9 μg/kg min) adjusted to achieve similar systemic hemodynamics. In addition to global oxygen delivery (DO2sys) and uptake (VO2sys) (indirect calorimetry) we measured gastric intramucosal pH (pHi) as well as splanchnic blood flow (Qspl), O2 delivery (DO2spl) and uptake (VO2spl) using the indocyanine-green steady state-infusion technique corrected for hepatic dye extraction. Data were obtained after at least 2 h of stable hemodynamic conditions.

Results

See table.

Conclusions

Replacing NOR by PHE selectively reduced Qspl and DO2spl without influencing pHi. Since VO2sys remained constant, this fall in Qspl, however, was unlikely to be to due to reduced regional O2 demands resulting from decreased β-adrenergic receptor-mediated thermogenesis [3]. Suppression of β-receptor stimulation, hence, may cause supply-dependency of VO2spl in septic shock.

Table

 

NOR1

PHE

NOR2

MAP (mmHg)

74± 4

74 ± 3

73 ± 3

CI (l/min m2)

  4.9± 1.4

  4.6 ± 1.0

  4.9 ± 1.4

DO2sys (ml/min m2)

 665 ± 152

  628 ± 102

  669 ± 147

VO2sys (ml/min m2)

177± 21

175 ± 25

179 ± 24

Qspl (l/min m2)

 1.40 ± 0.24

    0.93 ± 0.10*

  1.38 ± 0.22

DO2spl (ml/min m2)

192 ± 41

  126 ± 17*

188 ± 48

VO2spl (ml/min m2)

90 ± 9

    73 ± 15*

83 ± 9

pHi

  7.29 ± 0.08

  7.33 ± 0.10

  7.31 ± 0.08

All data mean ± SD; *P < 0.05 PHE versus NOR, Friedman-rank sign analysis of variance.

Authors’ Affiliations

(1)
P080: Sections Operative Intensivmedizin and Experimentelle Anästhesiologie, Universitätsklinik für Anästhesiologie, Klinikum der Universität

References

  1. Rudis MI, et al: . Crit Care Med. 1996, 24: 525-10.1097/00003246-199603000-00026.PubMedView ArticleGoogle Scholar
  2. Kvietys PR, Granger DN: . Am J Physiol. 1982, 243: G1-PubMedGoogle Scholar
  3. Unsaro A, et al: . Crit Care Med. 1995, 23: 674-10.1097/00003246-199504000-00015.View ArticleGoogle Scholar

Copyright

© Currnet Science Ltd 1997

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