Catecholamines and splanchnic perfusion

For supportive therapy in sepsis adequate volume loading is probably the fi rst, and possibly the most important step in the treatment of patients with septic shock. An elevated global O-2-supply (DO2) may be necessary and ben eficial in most of these patients, but the increase in DO2 should be guided by measurement of parameters assessing global and regional oxygenation. Ro utine strategies for elevating DO2 by the use of very high dosages of catec holamines cannot be recommended. Vasopressors should be used to achieve ade quate perfusion pressure. With noradrenaline, no negative effects on region al perfusion have been demonstrated when the patient is adequately volume-r esuscitated and the DO2 is normal or even slightly elevated. In contrast, a drenaline should be avoided because it appears to redistribute blood flow a way from the splanchnic region. There is controversy as to whether dopamine should still be used as a first-line drug in patients with septic shock, s ince some clinical and experimental data indicate unfavourable effects on m ucosal perfusion of the gut. To date there are no convincing data to suppor t the routine use of low-dose dopamine or dopexamine in patients with sepsi s. Neither low-dose dopamine nor dopexamine have been proved to prevent ren al failure in septic patients. Furthermore, there is evidence that low dose dopamine may reduce mucosal perfusion in the gut in some patients. Dopexam ine has been suggested for improvement of splanchnic perfusion, but since t hese effects remain somewhat controversial there are no current grounds for a general recommendation in favour of dopexamine in septic patients. These recommendations are currently limited by the lack of sufficient outcome st udies and studies evaluating regional perfusion. Until the various catechol amine regimes are more fully examined, recommendations for catecholamine su pport in sepsis must be considered "conditional".