R. Neviere et al., DOBUTAMINE IMPROVES GASTROINTESTINAL MUCOSAL BLOOD-FLOW IN A PORCINE MODEL OF ENDOTOXIC-SHOCK, Critical care medicine, 25(8), 1997, pp. 1371-1377
Objective: To test the hypothesis that saline solution plus dobutamine
increases gastrointestinal mucosal perfusion better than saline solut
ion alone in a model of endotoxic shock. Design: Prospective, randomiz
ed, unblinded study. Setting: Animal research laboratory affiliated wi
th a university teaching hospital. Subjects: Twelve female pigs, weigh
ing 30 to 32 kg. Interventions: Animals were anesthetized, and their l
ungs were mechanically ventilated, Catheters were inserted into the ri
ght atrium, pulmonary artery, and carotid artery for blood sampling an
d blood pressure and cardiac output measurements, A tonometer and a la
ser Doppler probe were placed in the lumen of the stomach and the ileu
m for determination of mucosal acid base status and measurement of muc
osal blood flow, Group 1 animals (n = 6) received an infusion (T = 0 m
in) of 150 mu g/kg Escherichia coli endotoxin and normal saline soluti
on (0.3 mL/kg/min), Group 2 animals (n = 6) received an infusion of en
dotoxin and were resuscitated with the same method as used in group 1,
but an infusion of dobutamine (5 mu g/kg/min) was begun at T = 60 min
s, and continued for the duration of the experiment. Measurements and
Main Results: Both experimental regimens produced shock, with decrease
d mean arterial pressure and systemic vascular resistance, without cha
nge in cardiac output and oxygen delivery, Endotoxin plus saline infus
ion decreased gastrointestinal mucosal blood flow to <60% of baseline
and decreased gastrointestinal pH. In contrast, gastrointestinal mucos
al blood flow returned to baseline values, and intramucosal pH tended
to normalize by the end of the saline solution plus dobutamine resusci
tative protocol. Conclusion: Compared with saline solution alone, sali
ne solu- tion plus dobutamine increased blood flow to the gastrointest
inal mucosa, and may have partially improved oxygenation.