EPINEPHRINE IMPAIRS SPLANCHNIC PERFUSION IN SEPTIC SHOCK

Objective: To assess the effects of epinephrine on splanchnic perfusio n and splanchnic oxygen uptake in patients with septic shock. Design: Prospective, controlled trial. Setting: University hospital intensive care unit (ICU). Patients: Eight patients with septic shock, according to the criteria of the 1992 American College of Chest Physicians/Soci ety of Critical Care Medicine Consensus Conference, requiring treatmen t with vasopressors. Interventions: We compared in crossover design a 2-hr infusion of epinephrine with dobutamine plus norepinephrine in ei ght ICU patients with septic shock, Systemic and splanchnic hemodynami cs and oxygen transport were measured before and during treatment with epinephrine. Measurements and Main Results: There was essentially no effect of epinephrine on the global parameters, except for increased l actate concentrations, There were marked effects on the regional varia bles; epinephrine caused lower splanchnic flow and oxygen uptake, lowe r mucosal pH, and higher hepatic vein lactate.Conclusion: We conclude that undesirable splanchnic effects on patients in whom that region is particularly fragile should be considered when using epinephrine for septic shock treatment.