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Influence of enoximone and dobutamine upon liver perfusion and function in fluid optimized septic patients
Critical Care volume 4, Article number: P44 (2000)
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 . The aim of this study was to investigate the impact of dobutamine and enoximone upon liver perfusion and function in fluid optimized septic patients.
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.
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.
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.
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Kern, H., Schröder, T., Kaulfuss, M. et al. Influence of enoximone and dobutamine upon liver perfusion and function in fluid optimized septic patients. Crit Care 4, P44 (2000). https://doi.org/10.1186/cc764
- Septic Patient
- Liver Perfusion
- Endotoxin Level
- Liver Blood Flow