Abstract
IntroductionMicrocirculatory blood flow, and notably gut perfusion, is important in the development of multiple organ failure in septic shock. We compared the effects of dopexamine and norepinephrine (noradrenaline) with those of epinephrine (adrenaline) on gastric mucosal blood flow (GMBF) in patients with septic shock. The effects of these drugs on oxidative stress were also assessed.MethodsThis was a prospective randomized study performed in a surgical intensive care unit among adults fulfilling usual criteria for septic shock. Systemic and pulmonary hemodynamics, GMBF (laser-Doppler) and malondialdehyde were assessed just before catecholamine infusion (T0), as soon as mean arterial pressure (MAP) reached 70 to 80 mmHg (T1), and 2 hours (T2) and 6 hours (T3) after T1. Drugs were titrated from 0.2 μg kg-1 min-1 with 0.2 μg kg-1 min-1 increments every 3 minutes for epinephrine and norepinephrine, and from 0.5 μg kg-1 min-1 with 0.5 μg kg-1 min-1 increments every 3 minutes for dopexamine.ResultsTwenty-two patients were included (10 receiving epinephrine, 12 receiving dopexamine–norepinephrine). There was no significant difference between groups on MAP at T0, T1, T2, and T3. Heart rate and cardiac output increased significantly more with epinephrine than with dopexamine–norepinephrine, whereas. GMBF increased significantly more with dopexamine–norepinephrine than with epinephrine between T1 and T3 (median values 106, 137, 133, and 165 versus 76, 91, 90, and 125 units of relative flux at T0, T1, T2 and T3, respectively). Malondialdehyde similarly increased in both groups between T1 and T3.ConclusionIn septic shock, at doses that induced the same effect on MAP, dopexamine–norepinephrine enhanced GMBF more than epinephrine did. No difference was observed on oxidative stress.
Highlights
Microcirculatory blood flow, and notably gut perfusion, is important in the development of multiple organ failure in septic shock
In septic shock, at doses that induced the same effect on mean arterial pressure (MAP), dopexamine–norepinephrine enhanced gastric mucosal blood flow (GMBF) more than epinephrine did
At doses that induced the same effect on MAP, dopexamine–norepinephrine enhanced GMBF more than epinephrine did
Summary
Microcirculatory blood flow, and notably gut perfusion, is important in the development of multiple organ failure in septic shock. In septic shock, when volume resuscitation fails to restore mean arterial pressure (MAP), catecholamines such as dopamine, dobutamine, epinephrine (adrenaline), or norepinephrine (noradrenaline) are used, either alone or in combination [1,2,3] Their effectiveness primarily reflects their cardiac and vascular actions, but their ability to modulate the sepsisinduced production of reactive oxygen species may participate [4]. Dopexamine is a structural and synthetic analog of dopamine that exerts systemic vasodilatation through the stimulation of β2 adrenoceptors and peripheral DA1 and DA2 receptors, and weak inotropic properties through the stimulation of β1 adrenoceptors This pharmacological profile could make the use of GMBF = gastric mucosal blood flow; MAP = mean arterial pressure; SAPS II = Simplified Acute Physiology Score II; SOFA = Sequential Organ Failure Assessment (page number not for citation purposes). The effects of these drugs on oxidative stress were assessed
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