Effects of dobutamine on gastric mucosal perfusion and hepatic metabolism in patients with septic shock

• Published in: American journal of respiratory and critical care medicine Vol. 160; no. 6; pp. 1983 - 1986
• Main Authors: JOLY, L.-M, MONCHI, M, CARIOU, A, CHICHE, J.-D, BELLENFANT, F, BRUNET, F, DHAINAUT, J.-F
• Format: Journal Article
• Language: English
• Published: New York, NY American Lung Association 01.12.1999
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Carbon Dioxide - blood; Cardiac Output - drug effects; Cardiotonic agents; Cardiovascular system; Dobutamine - pharmacology; Emergency and intensive care: infection, septic shock; Female; Gastric Mucosa - blood supply; Hemodynamics - drug effects; Humans; Indocyanine Green; Intensive care medicine; Liver - metabolism; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Prospective Studies; Regional Blood Flow - drug effects; Shock, Septic - blood; Shock, Septic - physiopathology; Human; Shock; Heart; Regional blood flow; Stomach; Agonist; Cardiotonic agent; Digestive system; Liver; Dobutamine; Cardiovascular disease; β-Adrenergic receptor agonist; Clearance; Metabolism; Infection; Chemotherapy; β1-Adrenergic receptor; Treatment; Cardic output; Adult; Hemodynamics; Biological effect
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.160.6.9708113

We prospectively evaluated the effects of dobutamine on gastric mucosal perfusion and hepatocytic clearance in patients with septic shock. After resuscitation with volume expansion and norepinephrine (12 patients) as needed, 14 hemodynamically stable patients (median age: 60 yr, median SAPS II score: 47) were given an infusion of 7.5 microg/kg/min dobutamine for 1 h. Gastric mucosal perfusion and hepatocytic clearance were assessed with tonometry and indocyanine green (ICG) elimination, respectively. All measurements were made before dobutamine infusion, after 1 h of dobutamine infusion, and 1 h after the infusion ended. Cardiac output (thermodilution technique) increased with dobutamine from a baseline median level of 4.0 L/min/m(2) (range: 1.7 to 7.4 L/min/m(2)) to 5.0 L/min/m(2) (range: 3.5 to 8.9 L/min/m(2)) (p = 0.004) and returned to baseline levels after dobutamine infusion ended. The gastric-arterial PCO(2) difference decreased from a baseline median level of 13 mm Hg (range: 5 to 54 mm Hg) to 7 mm Hg (range: 5 to 48 mm Hg) (p = 0.005). ICG elimination was low in all patients at baseline (median plasma disappearance rate: 12.2%; range: 7.6 to 16.2%) and did not change significantly during or after dobutamine infusion. In summary, dobutamine increases gastric mucosal perfusion but does not alter hepatocytic clearance in patients with septic shock. The absence of a beneficial effect of dobutamine on hepatocytic clearance may be related to profound alterations in hepatocellular metabolism during septic shock.