Document Detail


The effect of dobutamine infusion on splanchnic blood flow and oxygen transport in patients with acute pancreatitis.
MedLine Citation:
PMID:  9290985     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To measure the blood flow distribution and oxygen transport in pancreatitis and to evaluate the regional effects of increased systemic blood flow. DESIGN: Nonrandomized controlled trial. SETTING: A general intensive care unit in a tertiary care center. PATIENTS: 10 patients with pancreatitis requiring mechanical ventilation were studied after fluid resuscitation, and for the response to dobutamine, the patients served as their own controls. For the baseline, 11 patients scheduled for elective abdominal surgery served as a control group. INTERVENTIONS: Systemic and regional hemodynamics were measured after fluid resuscitation to predefined hemodynamic endpoints. In patients with pancreatitis, the measurement was repeated after cardiac output had been increased by at least 25% by dobutamine. MEASUREMENTS AND RESULTS: Hepatosplanchnic blood flow was estimated using regional catheterization and the dye dilution method. In patients with pancreatitis, the cardiac index did not differ from that of the control group (3.9 +/- 0.8 vs 4.1 +/- 0.71.min-1.m-2;NS). Accordingly, there was no difference in the splanchnic blood flow (1.1 +/- 0.4 vs 1.2 +/- 0.51.min-1.m-2;NS). Systemic and splanchnic oxygen consumption was increased in patients with pancreatitis (179 +/- 25 vs 147 +/- 27 ml.min-1.m-2, p < 0.05 and 68 +/- 15 vs 49 +/- 19 ml.min-1.m-2, p < 0.05), and systemic and splanchnic oxygen extraction was higher (0.34 +/- 0.08 vs 23 +/- 0.05, p < 0.01 and 0.46 +/- 0.18 vs 0.28 +/- 0.08, p < 0.05, respectively). Dobutamine had inconsistent effects on splanchnic blood flow: in individual patients, splanchnic blood flow even decreased substantially. CONCLUSIONS: In severe pancreatitis, oxygen consumption is increased in the splanchnic region; increased splanchnic oxygen demand is not always met by adequately increased blood flow. Increasing the systemic blood flow with dobutamine does not improve perfusion in the splanchnic bed.
Authors:
E Ruokonen; A Uusaro; E Alhava; J Takala
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Intensive care medicine     Volume:  23     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  1997 Jul 
Date Detail:
Created Date:  1997-10-22     Completed Date:  1997-10-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  732-7     Citation Subset:  IM    
Affiliation:
Department of Intensive Care, Kuopio University Hospital, Finland.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Cardiotonic Agents / therapeutic use*
Case-Control Studies
Dobutamine / therapeutic use*
Hemodynamics / drug effects
Humans
Male
Middle Aged
Oxygen Consumption / drug effects*
Pancreatitis / drug therapy*,  metabolism,  physiopathology*,  surgery
Splanchnic Circulation / drug effects*
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 34368-04-2/Dobutamine
Comments/Corrections
Comment In:
Intensive Care Med. 1997 Jul;23(7):715-7   [PMID:  9290983 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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