Study objective: To assess the effect of low dose dopexamine and dopam
ine on splanchnic blood flow as measured by gastric intramucosal pH, h
epatic metabolism of lidocaine (lignocaine) to monoethylglycinexylidid
e (MEGX), and plasma disappearance rate of indocyanine green (ICG). De
sign: Single-blind randomization of patients,vith a gastric intramucos
al acidosis to receive dopexamine (ten patients), dopamine (ten patien
ts), or saline solution (five control patients) for 2 h. Setting: All
25 patients were in the ICU of Guys' Hospital. Patients: All patients
met the criteria for the diagnosis of the systemic inflammatory respon
se syndrome, were mechanically ventilated, and had pulmonary artery ca
theters placed. All had a low gastric intramucosal pH and had a median
first 24-h acute physiology and chronic health evaluation (II) score
of 22 (range, 7 to 40). Measurements and interventions: Baseline measu
rements of gastric intramucosal pH, MEGX formation from lidocaine, ICG
plasma disappearance rate, heart rate, mean arterial pressure, pulmon
ary artery occlusion pressure, cardiac index, oxygen delivery index, o
xygen uptake index, systemic vascular resistance, and arterial pH were
taken. Dopexamine (1 mg . kg(-1). min(-1)), dopamine (2.5 mg . kg(-1)
. min(-1)), or 0.9% saline solution was then infused for 2 h, after wh
ich a repeated set of the measurements was taken. Results: Dopexamine
at a low dose had no effect on any of the systemic measurements. The m
edian intramucosal pH rose from 7.23 to 7.35 (p<0.005), the median ICG
plasma disappearance rate from 7.6 to 11.3% min(-1) (p<0.02), and the
median MEGX concentration from 4 to 10.2 ng . mL(-1) (p<0.005). Dopam
ine had no effect on any of the measured variables. There were no chan
ges in the control group. Conclusions: Low-dose dopexamine increases s
planchnic blood now as measured by gastric intramucosal pH, MEGX forma
tion from Lidocaine, and ICG clearance. The lack of any change in the
systemic measurements suggests that these effects are the result of a
selective vasodilatation of the splanchnic vessels. At the dose used i
n this study, dopamine had no effect on splanchnic blood flow. Dopexam
ine may be useful in the management of splanchnic ischemia in the crit
ically ill.