PMID- 10471606
OWN - NLM
STAT- MEDLINE
DCOM- 19991014
LR  - 20151119
IS  - 1073-449X (Print)
IS  - 1073-449X (Linking)
VI  - 160
IP  - 3
DP  - 1999 Sep
TI  - A dobutamine test can disclose hepatosplanchnic hypoperfusion in septic patients.
PG  - 839-45
AB  - In 36 hemodynamically stable septic patients, we explored whether changes in 
      gastric mucosal-arterial PCO(2) gradient (PCO(2)gap) induced by a short-term 
      dobutamine infusion may reveal hepatosplanchnic hypoperfusion. Hepatosplanchnic 
      blood flow (HSBF) was determined by the continuous indocyanine green infusion 
      technique and gastric mucosal PCO(2) (Pg(CO(2))) by saline tonometry. In each 
      patient, hemodynamic measurements, blood samples, and Pg(CO(2)) determinations 
      were performed three times: first at baseline (DOB 0), second during a dobutamine 
      infusion at a dose of 5 microgram/kg/min (DOB 5), and third at a dose of 10 
      microgram/kg/min (DOB 10). The results were analyzed by Wilcoxon's matched-pairs 
      signed rank test and are presented as medians with ranges. The PCO(2)gap 
      decreased preferentially in groups of patients with inadequate hepatosplanchnic 
      perfusion, i.e., with a low fractional HSBF (HSBF/CI), defined as the ratio of 
      the HSBF to the simultaneous cardiac index, or a high gradient between the mixed 
      venous blood and the suprahepatic blood O(2) saturations (DSvh(O(2))). In the 11 
      patients with a DSvh(O(2)) above 20% at baseline, PCO(2)gap decreased from 12.1 
      (6.3 to 19.5) mm Hg at DOB 0 to 6.2 (2.5 to 19. 3) mm Hg at DOB 5 (p < 0.001 
      versus DOB 0), and to 4.2 (0.1 to 35.9) mm Hg at DOB 10 (p < 0.05 versus DOB 5), 
      whereas in the 25 patients with a DSvh(O(2)) below 20% at baseline, PCO(2)gap did 
      not change significantly. At no time was the PCO(2)gap correlated with HSBF/CI or 
      DSvh(O(2)). We conclude that although the PCO(2)gap does not correlate well with 
      global indexes of gut oxygenation, such a simple dobutamine infusion test could 
      identify patients with inadequate hepatosplanchnic perfusion.
FAU - Creteur, J
AU  - Creteur J
AD  - Department of Intensive Care, Erasme University Hospital, Free University of 
      Brussels, Brussels, Belgium.
FAU - De Backer, D
AU  - De Backer D
FAU - Vincent, J L
AU  - Vincent JL
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Respir Crit Care Med
JT  - American journal of respiratory and critical care medicine
JID - 9421642
RN  - 0 (Sympathomimetics)
RN  - 142M471B3J (Carbon Dioxide)
RN  - 3S12J47372 (Dobutamine)
SB  - IM
MH  - Carbon Dioxide/physiology
MH  - Cardiac Output
MH  - Catheterization, Peripheral
MH  - Dobutamine/*pharmacology
MH  - Female
MH  - Gastric Mucosa/*blood supply/metabolism
MH  - Humans
MH  - Infusions, Intravenous
MH  - Linear Models
MH  - Liver Circulation/*drug effects
MH  - Male
MH  - Middle Aged
MH  - Oxygen Consumption
MH  - ROC Curve
MH  - Sensitivity and Specificity
MH  - Sepsis/blood/diagnosis/*physiopathology
MH  - Shock, Septic/blood/diagnosis/physiopathology
MH  - Splanchnic Circulation/*drug effects
MH  - Statistics, Nonparametric
MH  - Sympathomimetics/*pharmacology
EDAT- 1999/09/03 00:00
MHDA- 1999/09/03 00:01
CRDT- 1999/09/03 00:00
PHST- 1999/09/03 00:00 [pubmed]
PHST- 1999/09/03 00:01 [medline]
PHST- 1999/09/03 00:00 [entrez]
AID - 10.1164/ajrccm.160.3.9807029 [doi]
PST - ppublish
SO  - Am J Respir Crit Care Med. 1999 Sep;160(3):839-45. doi: 
      10.1164/ajrccm.160.3.9807029.