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Intensive Care Medicine
Erschienen in: Intensive Care Medicine 8/2003

01.08.2003 | Original

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

verfasst von: Andreas Nygren, Anders Thorén, Sven-Erik Ricksten

Erschienen in: Intensive Care Medicine | Ausgabe 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.
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Metadaten
Titel
Effects of norepinephrine alone and norepinephrine plus dopamine on human intestinal mucosal perfusion
verfasst von
Andreas Nygren
Anders Thorén
Sven-Erik Ricksten
Publikationsdatum
01.08.2003
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 8/2003
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-1829-5

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