The effect of increasing blood pressure with dopamine on systemic, splanchnic, and lower extremity hemodynamics in patients with acute liver failure

Background: Arterial hypotension occurs frequently in patients with acute l iver failure (ALF). Treatment with epinephrine and norepinephrine in patien ts with ALF has been associated with a decrease in whole-body (systemic) ox ygen consumption. We aimed to investigate the effect of increasing blood pr essure with dopamine on whole-body (systemic), splanchnic, and lower extrem ity hemodynamics and oxygen consumption in patients with acute liver failur e and hepatic encephalopathy grade III or IV. Methods: In seven patients wi th ALF cardiac output (CO) was measured with the thermodilution technique, and hepatic blood flow (HBF) was estimated with infusion of sorbitol as tes t compound, liver Vein catheterization, and calculations on the basis of Fi ck's principle. Lower-extremity blood flow was measured with strain-gauge p lethysmography. Results: During infusion of dopamine (5 +/- 2 mu g.kg(-1).m in(-1)) mean arterial pressure (MAP) increased from 68 +/- 5 to 85 +/- 8 mm Hg. CO increased from 6.8 +/- 0.8 to 39.0 +/- 2.4 1/min (P < 0.05), systemi c oxygen delivery from 45 +/- 7 to 63 +/- 19 mmol/min (P < 0.05), systemic oxygen consumption from 10.2 +/- 2.0 to 11.5 +/- 3.3 mmol/min (NS). HBF inc reased from 2.2 +/- 0.7 to 2.7 +/- 1.01/ min (P < 0.05), splanchnic oxygen delivery from 14.4 +/- 5.3 to 18.5 +/- 7.2 mmol/min (P < 0.01), and splanch nic oxygen consumption decreased from 3.9 +/- 1.1 to 2.9 +/- 0.6 mmol/min ( P < 0.05). No significant changes in lower extremity flow and oxygenation v ariables were found. Conclusions: The use of dopamine in patients with ALF to increase MAP was associated with increases in systemic and splanchnic ox ygen delivery. A concomitant decrease in splanchnic oxygen consumption was observed.