Dopexamine increases splanchnic blood flow but decreases gastric mucosal pH in severe septic patients treated with dobutamine

Objective: To assess the effects of dopexamine on splanchnic blood flow and splanchnic oxygen uptake in septic patients. Design:A prospective, controlled trial. Setting: A ten-bed intensive care unit (ICU) in a university hospital. Patients: Twelve patients with severe sepsis (according to the criteria of the 1992 American College of Chest Physicians/Society of Critical Care Medicine consensus conference) being stabilized by volume loading and treated to an elevated oxygen delivery by dobutamine infusion. Interventions: Infusion of increasing dosages of dopexamine (0.5, 1.0, 2.0, and 4.0 mu g/kg/min). Measurements and Main Results: Systemic and splanchnic hemodynamic and oxygen transport parameters as well as gastric mucosal pH (pHi) were measured. A hepatic venous catheter technique with indocyanine green dye dilution was used to determine splanchnic blood flow. Dopexamine increased global and splanchnic oxygen delivery without affecting oxygen consumption ((V) over dot O-2). Splanchnic blood flow increased proportionally to cardiac output, indicating that there was no selective effect of dopexamine an the splanchnic flow, Dopexamine decreased pHi in a dose-dependent fashion in all 12 patients. Conclusions: In hemodynamically stable, hyperdynamic septic patients being treated with dobutamine, dopexamine has no selective effect on splanchnic blood flow, In fact, a decreased pHi suggests a harmful effect on gastric mucosal perfusion.