THE EFFECT OF DOBUTAMINE INFUSION ON SPLANCHNIC BLOOD-FLOW AND OXYGEN-TRANSPORT IN PATIENTS WITH ACUTE-PANCREATITIS

Objectives: To measure the blood flow distribution and oxygen transpor t in pancreatitis and to evaluate the regional effects of in creased s ystemic blood flow. Design: Nonrandomized controlled trial. Setting: A general intensive care unit in a tertiary care center. Patients: 10 p atients with pancreatitis requiring mechanical ventilation were studie d after fluid resuscitation, and for the response to dobutamine, the p atients served as their own controls. For the baseline, 11 patients sc heduled for elective abdominal surgery served as a control group. Inte rventions: Systemic and regional hemodynamics were measured after flui d resuscitation to predefined hemodynamic endpoints. In patients with pancreatitis, the measurement was repeated after cardiac output had be en increased by at least 25 % by dobutamine. Measurements and results: Hepatosplanchnic blood flow was estimated using regional catheterizat ion and the dye dilution method. In patients with pancreatitis, the ca rdiac index did not differ from that of the control group (3.9 +/- 0.8 vs 4.1 +/- 0.71.min(-1).m(-2);NS). Accordingly, there was no differen ce in the splanchnic blood flow (1.1 +/- 0.4 vs 1.2 +/- 0.51.min(-1).m (-2);NS). Systemic and splanchnic oxygen consumption was increased in patients with pancreatitis (179 +/- 25 vs 147 +/- 27 ml.min(-1).m(-2), p < 0.05 and 68 +/- 15 vs 49 +/- 19 ml.min(-1).m(-2), p < 0.05), and systemic and splanchnic oxygen extraction was higher (0.34 +/- 0.08 vs 23 +/- 0.05, p < 0.01 and 0.46 +/- 0.18 vs 0.28 +/- 0.08, p < 0.05, re spectively). Dobutamine had inconsistent effects on splanchnic blood f low: in individual patients, splanchnic blood flow even decreased subs tantially. Conclusions: In severe pancreatitis, oxygen consumption is increased in the splanchnic region; increased splanchnic oxygen demand is not always met by adequately increased blood flow. Increasing the systemic blood now with dobutamine does not improve perfusion in the s planchnic bed.