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Published in: Intensive Care Medicine 8/2003

01-08-2003 | Original

Effects of norepinephrine alone and norepinephrine plus dopamine on human intestinal mucosal perfusion

Authors: Andreas Nygren, Anders Thorén, Sven-Erik Ricksten

Published in: Intensive Care Medicine | Issue 8/2003

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Abstract

Objectives

To evaluate the effect of norepinephrine alone and norepinephrine combined with dopamine on jejunal mucosal perfusion, gastric-arterial pCO2 gradient, and global splanchnic oxygen demand-supply relationship after cardiac surgery.

Design

A prospective interventional study.

Setting

A university cardiothoracic intensive care unit.

Patients

Eighteen patients were studied during propofol sedation and mechanical ventilation after uncomplicated coronary artery bypass surgery.

Interventions

After control measurements, each patient received norepinephrine (50±26 ng·kg·min) to increase mean arterial blood pressure by 30% followed by addition of low-dose dopamine (2.6±0.3 µg·kg·min). Postdrug control measurements were performed 120 min after discontinuation of the catecholamines.

Measurements and results

Norepinephrine induced a 32% increase in systemic vascular resistance with no change in cardiac index. Neither jejunal mucosal perfusion, assessed by laser Doppler flowmetry, nor gastric-arterial pCO2 gradient (tonometry) was affected by norepinephrine. Splanchnic O2-extraction increased (P<0.05) and this increase was positively correlated to the individual dose of norepinephrine (r = 0.78, P<0.0001). Splanchnic lactate extraction was increased by norepinephrine (P<0.05). None of the patients had splanchnic lactate production during norepinephrine infusion. The addition of dopamine increased cardiac index by 27% (P<0.001) and decreased splanchnic O2 extraction. Dopamine increased jejunal mucosal perfusion by 32% (P<0.001) while the gastric-arterial pCO2 gradient remained unchanged.

Conclusions

Vasopressor therapy with norepinephrine after cardiac surgery did not jeopardize intestinal mucosal perfusion in spite of a dose-dependent increase of the global splanchnic oxygen demand-supply relationship. The addition of dopamine increased intestinal mucosal perfusion.
Literature
1.
go back to reference Task Force of the American College of Critical Care Medicine, S.o.C.C.M (1999) Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Crit Care Med 27:639–660PubMed Task Force of the American College of Critical Care Medicine, S.o.C.C.M (1999) Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Crit Care Med 27:639–660PubMed
2.
go back to reference Dunser MW, Mayr AJ, Ulmer H, Ritsch N, Knotzer H, Pajk W, Luckner G, Mutz NJ, Hasibeder WR (2001) The effects of vasopressin on systemic hemodynamics in catecholamine-resistant septic and postcardiotomy shock: a retrospective analysis. Anesth Analg 93:7–13PubMed Dunser MW, Mayr AJ, Ulmer H, Ritsch N, Knotzer H, Pajk W, Luckner G, Mutz NJ, Hasibeder WR (2001) The effects of vasopressin on systemic hemodynamics in catecholamine-resistant septic and postcardiotomy shock: a retrospective analysis. Anesth Analg 93:7–13PubMed
3.
go back to reference Landry DW, Oliver JA (2001) The pathogenesis of vasodilatory shock. N Engl J Med 345:588–595PubMed Landry DW, Oliver JA (2001) The pathogenesis of vasodilatory shock. N Engl J Med 345:588–595PubMed
4.
go back to reference Ruokonen E, Takala J, Kari A, Saxen H, Mertsola J, Hansen EJ (1993) Regional blood flow and oxygen transport in septic shock. Crit Care Med 21:1296–1303PubMed Ruokonen E, Takala J, Kari A, Saxen H, Mertsola J, Hansen EJ (1993) Regional blood flow and oxygen transport in septic shock. Crit Care Med 21:1296–1303PubMed
5.
go back to reference Sakka SG, Meier-Hellmann A, Reinhart K (2000) Do fluid administration and reduction in norepinephrine dose improve global and splanchnic haemodynamics? Br J Anaesth 84:758–762 Sakka SG, Meier-Hellmann A, Reinhart K (2000) Do fluid administration and reduction in norepinephrine dose improve global and splanchnic haemodynamics? Br J Anaesth 84:758–762
6.
go back to reference Meier-Hellmann A, Specht M, Hannemann L, Hassel H, Bredle DL, Reinhart K (1996) Splanchnic blood flow is greater in septic shock treated with norepinephrine than in severe sepsis. Intensive Care Med 22:1354–1359PubMed Meier-Hellmann A, Specht M, Hannemann L, Hassel H, Bredle DL, Reinhart K (1996) Splanchnic blood flow is greater in septic shock treated with norepinephrine than in severe sepsis. Intensive Care Med 22:1354–1359PubMed
7.
go back to reference Meier-Hellmann A, Reinhart K, Bredle DL, Specht M, Spies CD, Hannemann L (1997) Epinephrine impairs splanchnic perfusion in septic shock. Crit Care Med 25:399–404PubMed Meier-Hellmann A, Reinhart K, Bredle DL, Specht M, Spies CD, Hannemann L (1997) Epinephrine impairs splanchnic perfusion in septic shock. Crit Care Med 25:399–404PubMed
8.
go back to reference Reinelt H, Radermacher P, Kiefer P, Fischer G, Wachter U, Vogt J, Georgieff M (1999) Impact of exogenous beta-adrenergic receptor stimulation on hepatosplanchnic oxygen kinetics and metabolic activity in septic shock. Crit Care Med 27:325–331PubMed Reinelt H, Radermacher P, Kiefer P, Fischer G, Wachter U, Vogt J, Georgieff M (1999) Impact of exogenous beta-adrenergic receptor stimulation on hepatosplanchnic oxygen kinetics and metabolic activity in septic shock. Crit Care Med 27:325–331PubMed
9.
go back to reference Thoren A, Jakob SM, R Pradl R, Elam M, Ricksten SE, Takala J (2000) Jejunal and gastric mucosal perfusion versus splanchnic blood flow and metabolism: an observational study on postcardiac surgical patients. Crit Care Med 28:3649–3654PubMed Thoren A, Jakob SM, R Pradl R, Elam M, Ricksten SE, Takala J (2000) Jejunal and gastric mucosal perfusion versus splanchnic blood flow and metabolism: an observational study on postcardiac surgical patients. Crit Care Med 28:3649–3654PubMed
10.
go back to reference Cain S (1996) Gut oxygenation after reduced oxygen delivery. Vincent J (ed) Yearbook of intensive care and emergency medicine. Springer, Berlin Heidelberg, pp 219–226 Cain S (1996) Gut oxygenation after reduced oxygen delivery. Vincent J (ed) Yearbook of intensive care and emergency medicine. Springer, Berlin Heidelberg, pp 219–226
11.
go back to reference Pastores SM, Katz DP, Kvetan V (1996) Splanchnic ischemia and gut mucosal injury in sepsis and the multiple organ dysfunction syndrome. Am J Gastroenterol 91:1697–1710PubMed Pastores SM, Katz DP, Kvetan V (1996) Splanchnic ischemia and gut mucosal injury in sepsis and the multiple organ dysfunction syndrome. Am J Gastroenterol 91:1697–1710PubMed
12.
go back to reference Thoren A, Elam M, Ricksten SE (2000) Differential effects of dopamine, dopexamine, and dobutamine on jejunal mucosal perfusion early after cardiac surgery. Crit Care Med 28:2338–2343PubMed Thoren A, Elam M, Ricksten SE (2000) Differential effects of dopamine, dopexamine, and dobutamine on jejunal mucosal perfusion early after cardiac surgery. Crit Care Med 28:2338–2343PubMed
13.
go back to reference Thoren A, Elam M, Ricksten SE (2001) Jejunal mucosal perfusion is well maintained during mild hypothermic cardiopulmonary bypass in humans. Anesth Analg 92:5–11PubMed Thoren A, Elam M, Ricksten SE (2001) Jejunal mucosal perfusion is well maintained during mild hypothermic cardiopulmonary bypass in humans. Anesth Analg 92:5–11PubMed
14.
go back to reference Schwarz B, Hofstotter H, Salak N, Pajk W, Knotzer H, Mayr A, Labeck B, Kafka R, Ulmer H, Hasibeder W (2001) Effects of norepinephrine and phenylephrine on intestinal oxygen supply and mucosal tissue oxygen tension. Intensive Care Med 27:593–601PubMed Schwarz B, Hofstotter H, Salak N, Pajk W, Knotzer H, Mayr A, Labeck B, Kafka R, Ulmer H, Hasibeder W (2001) Effects of norepinephrine and phenylephrine on intestinal oxygen supply and mucosal tissue oxygen tension. Intensive Care Med 27:593–601PubMed
15.
go back to reference Sautner T, Wessely C, Riegler M, Sedivy R, Gotzinger P, Losert U, Roth E, Jakesz R, Fugger R (1998) Early effects of catecholamine therapy on mucosal integrity, intestinal blood flow, and oxygen metabolism in porcine endotoxin shock. Ann Surg 228:239–248CrossRefPubMed Sautner T, Wessely C, Riegler M, Sedivy R, Gotzinger P, Losert U, Roth E, Jakesz R, Fugger R (1998) Early effects of catecholamine therapy on mucosal integrity, intestinal blood flow, and oxygen metabolism in porcine endotoxin shock. Ann Surg 228:239–248CrossRefPubMed
16.
go back to reference Trager K, Radermacher P, Rieger KM, Grover R, Vlatten A, Iber T, Adler J, Georgieff M, Santak B (2000) Norepinephrine and N(G)-monomethyl-L-arginine in hyperdynamic septic shock in pigs: effects on intestinal oxygen exchange and energy balance. Crit Care Med 28:2007–2014PubMed Trager K, Radermacher P, Rieger KM, Grover R, Vlatten A, Iber T, Adler J, Georgieff M, Santak B (2000) Norepinephrine and N(G)-monomethyl-L-arginine in hyperdynamic septic shock in pigs: effects on intestinal oxygen exchange and energy balance. Crit Care Med 28:2007–2014PubMed
17.
go back to reference Revelly JP, Liaudet L, Frascarolo P, Joseph JM, Martinet O, Markert M (2000) Effects of norepinephrine on the distribution of intestinal blood flow and tissue adenosine triphosphate content in endotoxic shock. Crit Care Med 28:2500–2506 Revelly JP, Liaudet L, Frascarolo P, Joseph JM, Martinet O, Markert M (2000) Effects of norepinephrine on the distribution of intestinal blood flow and tissue adenosine triphosphate content in endotoxic shock. Crit Care Med 28:2500–2506
18.
go back to reference Crissinger KD, Kvietys PR, Granger DN (1988) Autoregulatory escape from norepinephrine infusion: roles of adenosine and histamine. Am J Physiol 254:G560–565PubMed Crissinger KD, Kvietys PR, Granger DN (1988) Autoregulatory escape from norepinephrine infusion: roles of adenosine and histamine. Am J Physiol 254:G560–565PubMed
19.
go back to reference Guth PH, Ross G, Smith E (1976) Changes in intestinal vascular diameter during norepinephrine vasoconstrictor escape. Am J Physiol 230:1466–1468PubMed Guth PH, Ross G, Smith E (1976) Changes in intestinal vascular diameter during norepinephrine vasoconstrictor escape. Am J Physiol 230:1466–1468PubMed
20.
go back to reference Thoren A, Ricksten SE, Lundin S, Gazelius B, Elam M (1998) Baroreceptor-mediated reduction of jejunal mucosal perfusion, evaluated with endoluminal laser Doppler flowmetry in conscious humans. J Auton Nerv Syst 68:157–163CrossRefPubMed Thoren A, Ricksten SE, Lundin S, Gazelius B, Elam M (1998) Baroreceptor-mediated reduction of jejunal mucosal perfusion, evaluated with endoluminal laser Doppler flowmetry in conscious humans. J Auton Nerv Syst 68:157–163CrossRefPubMed
21.
go back to reference Sjovall H, Redfors S, Biber B, Jodal M, Lundgren O (1984) Effect of intravenous dopamine infusion on intramural blood flow distribution and fluid absorption in the feline small intestine. Scand J Gastroenterol 19:411–416PubMed Sjovall H, Redfors S, Biber B, Jodal M, Lundgren O (1984) Effect of intravenous dopamine infusion on intramural blood flow distribution and fluid absorption in the feline small intestine. Scand J Gastroenterol 19:411–416PubMed
22.
go back to reference Kullman T, Breull W, Wasserman K (1983) Blood flow redistribution by dopamine in the feline gastrointestinal tract. Naunyn Schmiedebergs Arch Pharmacol 323:145–148PubMed Kullman T, Breull W, Wasserman K (1983) Blood flow redistribution by dopamine in the feline gastrointestinal tract. Naunyn Schmiedebergs Arch Pharmacol 323:145–148PubMed
23.
go back to reference Hasibeder W, Germann R, Wolf HJ, Haisjackl M, Hausdorfer H, Riedmann B, Bonatii J, Gruber E, Schwarz B, Waldenberger P, Friesenecker B, Furtner B (1996) Effects of short-term endotoxemia and dopamine on mucosal oxygenation in porcine jejunum. Am J Physiol 270:G667–675PubMed Hasibeder W, Germann R, Wolf HJ, Haisjackl M, Hausdorfer H, Riedmann B, Bonatii J, Gruber E, Schwarz B, Waldenberger P, Friesenecker B, Furtner B (1996) Effects of short-term endotoxemia and dopamine on mucosal oxygenation in porcine jejunum. Am J Physiol 270:G667–675PubMed
24.
go back to reference Germann R, Haisjackl M, Hasibeder W, Sparr H, Luz G, Plattner R, Pernthaler H, Friesenecker B, Falk M (1994) Dopamine and mucosal oxygenation in the porcine jejunum. J Appl Physiol 77:2845–2852PubMed Germann R, Haisjackl M, Hasibeder W, Sparr H, Luz G, Plattner R, Pernthaler H, Friesenecker B, Falk M (1994) Dopamine and mucosal oxygenation in the porcine jejunum. J Appl Physiol 77:2845–2852PubMed
25.
go back to reference Karzai W, Gunnicker M, Scharbert G, Vorgrimler-Karzai UM, Priebe HJ (1996) Effects of dopamine on oxygen consumption and gastric mucosal blood flow during cardiopulmonary bypass in humans. Br J Anaesth 77:603–606PubMed Karzai W, Gunnicker M, Scharbert G, Vorgrimler-Karzai UM, Priebe HJ (1996) Effects of dopamine on oxygen consumption and gastric mucosal blood flow during cardiopulmonary bypass in humans. Br J Anaesth 77:603–606PubMed
26.
go back to reference Karzai W, Lotte A, Gunnicker M, Vorgrimler-Karzai UM, Priebe HJ (1996) Dobutamine increases oxygen consumption during constant flow cardiopulmonary bypass. Br J Anaesth 76:5–8PubMed Karzai W, Lotte A, Gunnicker M, Vorgrimler-Karzai UM, Priebe HJ (1996) Dobutamine increases oxygen consumption during constant flow cardiopulmonary bypass. Br J Anaesth 76:5–8PubMed
27.
go back to reference Neviere R, Mathieu D, Chagnon JL, Lebleu N, Wattel F (1996) The contrasting effects of dobutamine and dopamine on gastric mucosal perfusion in septic patients. Am J Respir Crit Care Med 154:1684–1688PubMed Neviere R, Mathieu D, Chagnon JL, Lebleu N, Wattel F (1996) The contrasting effects of dobutamine and dopamine on gastric mucosal perfusion in septic patients. Am J Respir Crit Care Med 154:1684–1688PubMed
28.
go back to reference Jakob SM, Kosonen P, Ruokonen E, Parviainen I, Takala J (1999) The Haldane effect—an alternative explanation for increasing gastric mucosal PCO2 gradients? Br J Anaesth 83:740–746 Jakob SM, Kosonen P, Ruokonen E, Parviainen I, Takala J (1999) The Haldane effect—an alternative explanation for increasing gastric mucosal PCO2 gradients? Br J Anaesth 83:740–746
29.
go back to reference Arnold J, Hendriks J, Ince C, Bruining H (1994) Tonometry to assess the adequacy of splanchnic oxygenation in the critically ill patient. Intensive Care Med 20:452–456PubMed Arnold J, Hendriks J, Ince C, Bruining H (1994) Tonometry to assess the adequacy of splanchnic oxygenation in the critically ill patient. Intensive Care Med 20:452–456PubMed
30.
go back to reference Russell JA (1997) Gastric tonometry: does it work? Intensive Care Med 23:3–6 Russell JA (1997) Gastric tonometry: does it work? Intensive Care Med 23:3–6
31.
go back to reference Jakob SM, Ruokonen E, Takala J (2002) Effects of dopamine on systemic and regional blood flow and metabolism in septic and cardiac surgery patients. Shock 18:8–13PubMed Jakob SM, Ruokonen E, Takala J (2002) Effects of dopamine on systemic and regional blood flow and metabolism in septic and cardiac surgery patients. Shock 18:8–13PubMed
32.
go back to reference Uusaro A, Russell JA, Walley KR, Takala J (2000) Gastric-arterial PCO2 gradient does not reflect systemic and splanchnic hemodynamics or oxygen transport after cardiac surgery. Shock 14:13–17PubMed Uusaro A, Russell JA, Walley KR, Takala J (2000) Gastric-arterial PCO2 gradient does not reflect systemic and splanchnic hemodynamics or oxygen transport after cardiac surgery. Shock 14:13–17PubMed
33.
go back to reference Thollander M, Hellstrom PM, Svensson TH, Gazelius B (1996) Haemodynamic changes in the small intestine correlate to migrating motor complex in humans. Eur J Gastroenterol Hepatol 8:777–785PubMed Thollander M, Hellstrom PM, Svensson TH, Gazelius B (1996) Haemodynamic changes in the small intestine correlate to migrating motor complex in humans. Eur J Gastroenterol Hepatol 8:777–785PubMed
34.
go back to reference Johansson K, Jakobsson A, Lindahl K, Lindhagen J, Lundgren O, Nilsson GE (1991) Influence of fibre diameter and probe geometry on the measuring depth of laser Doppler flowmetry in the gastrointestinal application. Int J Microcirc Clin Exp. 10:219–229 Johansson K, Jakobsson A, Lindahl K, Lindhagen J, Lundgren O, Nilsson GE (1991) Influence of fibre diameter and probe geometry on the measuring depth of laser Doppler flowmetry in the gastrointestinal application. Int J Microcirc Clin Exp. 10:219–229
35.
go back to reference Bloom W, Fawcett DW (1994) A textbook of histology. Chapman and Hall, New York, pp 617–620 Bloom W, Fawcett DW (1994) A textbook of histology. Chapman and Hall, New York, pp 617–620
36.
go back to reference Ahn H, Lindhagen J, Nilsson GE, Oberg PA, Lundgren O (1986) Assessment of blood flow in the small intestine with laser Doppler flowmetry. Scand J Gastroenterol 21:863–870 Ahn H, Lindhagen J, Nilsson GE, Oberg PA, Lundgren O (1986) Assessment of blood flow in the small intestine with laser Doppler flowmetry. Scand J Gastroenterol 21:863–870
37.
go back to reference Ahn H, Lindhagen J, Nilsson GE, Salerud EG, Jodal M, Lundgren O (1985) Evaluation of laser Doppler flowmetry in the assessment of intestinal blood flow in cat. Gastroenterology 88:951–957PubMed Ahn H, Lindhagen J, Nilsson GE, Salerud EG, Jodal M, Lundgren O (1985) Evaluation of laser Doppler flowmetry in the assessment of intestinal blood flow in cat. Gastroenterology 88:951–957PubMed
38.
go back to reference Kvietys PR, Shepherd AP, Granger DN (1985) Laser-Doppler, H2 clearance, and microsphere estimates of mucosal blood flow. Am J Physiol 249:G221–227PubMed Kvietys PR, Shepherd AP, Granger DN (1985) Laser-Doppler, H2 clearance, and microsphere estimates of mucosal blood flow. Am J Physiol 249:G221–227PubMed
Metadata
Title
Effects of norepinephrine alone and norepinephrine plus dopamine on human intestinal mucosal perfusion
Authors
Andreas Nygren
Anders Thorén
Sven-Erik Ricksten
Publication date
01-08-2003
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 8/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-1829-5

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