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Splanchnic blood flow is greater in septic shock treated with norepinephrine than in severe sepsis

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Abstract

Objective

To assess global and splanchnic blood flow and oxygen transport in patients with sepsis with and without norepinephrine treatment.

Design

Prospective, clinical study.

Setting

University hospital intensive care unit.

Patients

A convenience sample of 15 septic shock patients treated with norepinephrine and 13 patients with severe sepsis who did not receive norepinephrine.

Measurements and main results

There were no differences between the two groups in global haemodynamics and oxygen transport. Splanchnic blood flow and oxygen delivery (splanchnic DO2 303±43 ml/min per m2) and consumption (splanchnic VO2 100±13 ml/min per m2) were much higher in the septic shock group compared with the severe sepsis group (splanchnic DO2 175±19 ml/min per m2, splanchnic VO2 61±6 ml/min per m2). Gastric mucosal pH was subnormal in both groups (septic shock 7.29±0.02, severe sepsis 7.25±0.02) with no significant difference. No significant differences between groups were detected in lactate values.

Conclusion

These data confirm a redistribution of blood flow to the splanchnic region in sepsis that is even more pronounced in patients with septic shock requiring norepinephrine. However, subnormal gastric mucosal pH suggested inadequate oxygenation in part of the splanchnic region due to factors other than splanchnic hypoperfusion. Progress in this area will depend on techniques that address not only total splanchnic blood flow, but also inter-organ flow distribution, intra-organ distribution, and other microcirculatory or metabolic malfunctions.

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References

  1. Deitch EA, Berg R, Specian R (1987) Endotoxin promotes the translocation of bacteria from the gut. Arch Surg 122:185–190

    PubMed  Google Scholar 

  2. Marshall JC, Christou NV, Horn R Meakins JL (1988) The microbiology of multiple organ failure: the proximal GI tract as an occult reservoir of pathogens. Arch Surg 123:309–315

    PubMed  Google Scholar 

  3. Meakins JL, Marshall JC (1989) The gut as the motor of multiple system organ failure. In: Marston A, Bulkley GB, Fiddian Green RG, Haglund R 6 (eds). Splanchnic ischemia and multiple organ failure. Mosby, St. Louis, pp 339–348

    Google Scholar 

  4. Fong Y, Marano MA, Moldawer LL, Wei H, Calvano SE, Kenney JS, Allison AC, Cerami A, Shires GT, Lowry SF (1990) The acute splanchnic and peripheral tissue metabolic response to endotoxin in humans. J Clin Invest 85:1896–1904

    PubMed  Google Scholar 

  5. Ruokonen E, Takala J, Kari A, Saxén H, Mertsola J, Hansen E (1993) Regional blood flow and oxygen transport in septic shock. Crit Care Med 21:1296–1303

    PubMed  Google Scholar 

  6. Giraud GD, MacCannell KL (1984) Decreased nutrient blood flow during dopamine-and epinephrine-induced intestinal vasodilatation. J Pharm Exp Ther 230:214–220

    Google Scholar 

  7. Nelson DP, Samsel RW, Wood LD, Schumacker PT (1988) Pathologic supply dependence of systemic and intestinal O2 uptake during endotoxemia. J Appl Physiol 64:2410–2419

    PubMed  Google Scholar 

  8. Pawlik W, Shepherd AP, Jacobson ED (1975) Effects of vasoactive agents on intestinal oxygen consumption and blood flow in dogs. J Clin Invest 56:484–490

    PubMed  Google Scholar 

  9. Pawlik WW, Shepherd AP, Mailman D, Shanbour LL, Jacobson ED (1976) Effects of dopamine and epinephrine on intestinal blood flow and oxygen uptake. In: Grote J, Reneau D, Thews G (eds). Oxygen transport to the tissue-II. Plenum, New York London, pp 511–516

    Google Scholar 

  10. Richardson PDI, Granger DN, Kvietys PR (1980) Effects of norepinephrine, vasopressin, isoproterenol, and histamine on blood flow, oxygen uptake, and capillary filtration coefficient in the colon of the anesthetized dog. Gastroenterology 78:1537–1544

    PubMed  Google Scholar 

  11. Shepherd AP, Mailman D, Burks TF, Granger HJ (1973) Effects of norepinephrine and sympathetic stimulation on extraction of oxygen and86Rb in perfused canine small bowel. Circ Res 33:166–174

    PubMed  Google Scholar 

  12. Shepherd AP, Pawlik W, Mailman D, Burks TF, Jacobson ED (1976) Effects of vasoconstrictors on intestinal vascular resistance and oxygen extraction. Am J Physiol 230:298–303

    PubMed  Google Scholar 

  13. Gutierrez G, Palizas F, Doglio G, Wainsztein N, Gallesio A, Pacin J, Dubin A, Schiavi E, Jorge M, Pusajo J, Klein F, San Roman E, Dorfman B, Shottlender J, Giniger R (1992) Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients. Lancet 339:195–199

    PubMed  Google Scholar 

  14. Smithies M, Yee TH, Jackson L, Beale R, Bihari D (1994) Protecting the gut and the liver in the critically ill: effects of dobutamine. Crit Care Med 22:789–795

    PubMed  Google Scholar 

  15. Silverman HJ, Tuma P (1992) Gastric tomometry in patients with sepsis. Effects of dobutamine infusions and packed red blood cell transfusions. Chest 102:184–188

    PubMed  Google Scholar 

  16. Members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874

    Google Scholar 

  17. Caesar J, Shaldon S, Chiandussi L, Guevara L, Sherlock S (1961) The use of indocyanine green in the measurement of hepatic blood flow and as a test of hepatic function. Clin Sci 21:43–57

    PubMed  Google Scholar 

  18. Gottlieb ME, Strarron HH, Newell JC, Shah DM (1984) Indocyanine green: its use as an early indicator of hepatic dysfunction following injury in man. Arch Surg 119:264–268

    PubMed  Google Scholar 

  19. Wahren J (1994) Splanchnic fractional extraction of different indocyanine green dye preparations in humans (abstract). Clinical Intensive Care 5 [Suppl]:47

    Google Scholar 

  20. Imamura M, Clowes GHA (1975) Hepatic blood flow and oxygen consumption in starvation, sepsis and septic shock. J Am Coll Surg 141:27–34

    Google Scholar 

  21. Norton L, Moore G, Eiseman B (1975) Liver failure in the postoperative patient: the role of sepsis and immunologic deficiency. Surgery 78:6–13

    PubMed  Google Scholar 

  22. Dahn MS, Lange P, Lobdell K, Hans B, Jacobs LA, Mitchell RA (1987) Splanchnic and total body oxygen consumption differences in septic and injured patients. Surgery 101:69–80

    PubMed  Google Scholar 

  23. Steffes CP, Dahn MS, Lange MP (1994) Oxygen transport-dependent splanchnic metabolism in the sepsis syndrome. Arch Surg 129:46–52

    PubMed  Google Scholar 

  24. Fink MP (1993) Adequacy of gut oxygenation in endotoxemia and sepsis. Crit Care Med 21 [Suppl]:4–8

    PubMed  Google Scholar 

  25. VanderMeer TJ, Wang H, Fink MP (1995) Endotoxemia causes ileal mucosal acidosis in the absence of mucosal hypoxia in a normodynamic porcine model of septic shock. Crit Care Med 23:1217–1226

    PubMed  Google Scholar 

  26. Uusaro A, Ruokonen E, Takala J (1995) Gastric mucosal pH does not reflect changes in splanchnic blood flow after cardiac surgery. Br J Anaesth 74:149–154

    PubMed  Google Scholar 

  27. Lang CH, Bagby GJ, Ferguson JL, Spitzer JJ (1984) Cardiac output and redistribution of organ blood flow in hypermetabolic sepsis. Am J Physiol 246R:331–337

    Google Scholar 

  28. Gutierrez G (1991) Cellular energy metabolism during hypoxia. Crit Care Med 19:619–626

    PubMed  Google Scholar 

  29. Cain SM, Curtis S (1991) Experimental models of pathologic oxygen supply dependency. Crit Care Med 19:603–612

    PubMed  Google Scholar 

  30. Hotchkiss RS, Karl IE (1992) Reevaluation of the role of cellular hypoxia and bioenergenic failure in sepsis. JAMA 267:1503–1510

    PubMed  Google Scholar 

  31. Vallet B, Lund N, Curtis SE, Kelly D, Cain SM (1994) Gut and muscle tissue PO2 in endotoxemic dogs during shock and resuscitation. J Appl Physiol 76:793–800

    PubMed  Google Scholar 

  32. Johnson GA, McNamara JJ (1981) Organ ischemia after hemorrhagic shock. Surg Forum 32:24–26

    Google Scholar 

  33. Knisely MH, Harding F, Debacker H (1957) Hepatic sphincters. Science 125:1023–1026

    PubMed  Google Scholar 

  34. Leevy CM, George W, Lesko W, Deysine M, Abbott CC, Halligan EJ (1961) Observations on hepatic oxygen metabolism in man. JAMA 178:565–567

    PubMed  Google Scholar 

  35. Breslow MJ, Miller CF, Parker SD, Walman AT, Traystman RJ (1987) Effect of vasopressors on organ blood flow during endotoxin shock in pigs. Am J Physiol 252H:291–300

    Google Scholar 

  36. Marik PE, Mohedin M (1994) The contrasting effects of dopamine and norepinephrine on systemic and splanchnic oxygen ultilization in hyperdynamic sepsis. JAMA 272:1354–1357

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesia and Critical Care Medicine, Friedrich Schiller University Jena, Bachstrasse 18, D-07743, Jena, Germany

    A. Meier-Hellmann, M. Specht, L. Hannemann & K. Reinhart

  2. Department of Anesthesia and Critical Care Medicine, Benjamin Franklin Clinic, Free University of Berlin, Germany

    A. Meier-Hellmann & H. Hassel

  3. Department of Internal Medicine, Northeastern Ohio University College of Medicine, Rootstown, Ohio, USA

    D. L. Bredle

Authors
  1. A. Meier-Hellmann
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  2. M. Specht
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  3. L. Hannemann
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  4. H. Hassel
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  5. D. L. Bredle
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  6. K. Reinhart
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Meier-Hellmann, A., Specht, M., Hannemann, L. et al. Splanchnic blood flow is greater in septic shock treated with norepinephrine than in severe sepsis. Intensive Care Med 22, 1354–1359 (1996). https://doi.org/10.1007/BF01709551

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  • DOI: https://doi.org/10.1007/BF01709551

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