Advertisement

Cardiovascular Support by Hemodynamic Subset: Sepsis

  • A. Meier-Hellmann
  • K. Reinhart
Chapter
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 28)

Abstract

Multiple organ failure (MOF) is the major cause of death in patients with sepsis [1]. Macro and micro circulatory maldistribution of blood flow to the tissues and hypoxia of certain organs plays an important role in the pathogenesis of sepsis [2, 3]. In addition, there is evidence in the literature for an oxygen extraction deficit. Therefore a supranormal oxygen delivery (DO2) is considered by many to be essential for adequate tissue oxygenation [4, 5]. Sufficient volume substitution and treatment with catecholamines are usually required to achieve a supranormal oxygen delivery and an adequate systemic perfusion pressure. Despite this, the mortality rate of sepsis and the incidence of MOF remains persistantly high [6]. It is obvious that under the conditions of a supranormal D02 tissue hypoxia in various tissues may still occur [2, 4]. Information regarding perfusion and oxygenation in different regions of the body is mandatory for the detection of regional tissue hypoxia.

Keywords

Septic Shock Mean Arterial Pressure Septic Patient Renal Blood Flow Hepatic Blood Flow 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Fiddian-Green RG (1991) Role of gut in shock and resuscitation. In: Stoutenbeck CP, van Saene HKF (eds) Infection and the anesthetist, Vol 5 (1). Bailliere Tindall/WB Saunders Company, London, pp 75–99.Google Scholar
  2. 2.
    Schumacker P, Cain S (1987) The concept of a critical oxygen delivery. Intensive Care Med 13:223–229.PubMedCrossRefGoogle Scholar
  3. 3.
    Sibbald WJ, Bersten A, Rutledge FS (1989) The role of tissue hypoxia in multiple organ failure. In: Reinhart K, Eyrich K (eds) Clinical aspects of oxygen transport and tissue oxygenation. Springer, Berlin Heidelberg New York 1989, pp 102–114.Google Scholar
  4. 4.
    Gilbert EM, Haupt MT, Mandanas RY, Huaringa AJ, Carlson RW (1986) The effect of fluid loading, blood transfusion, and catecholamine infusion on oxygen delivery and consumption in patients with sepsis. Am Respir Dis Rev 134:873–878.Google Scholar
  5. 5.
    Kaufman BS, Rackow EC, Falk JL (1984) The Relationship Between Oxygen Delivery and Consumption during Fluid Resuscitation- of Hypovolemic and Septic Shock. Chest 85,3: 337–340.CrossRefGoogle Scholar
  6. 6.
    Parker MM, Parillo JF (1983) Septic shock. Hemodynamics and pathogenesis. JAMA 250: 3324–3327.Google Scholar
  7. 7.
    Fry DE, Pearlstein L, Fulton RL (1980) Multiple-system organ failure: the role of uncontrolled infection. Arch Surg 115:136–140.PubMedGoogle Scholar
  8. 8.
    Lucas CE (1976) The renal response to acute injury and sepsis. Surg Clin North Am 56: 953–975.PubMedGoogle Scholar
  9. 9.
    Tran DD, Groeneveld ABJ, Van der Meulen J, et al. (1990) Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit. Crit Care Med 18:474–479.PubMedCrossRefGoogle Scholar
  10. 10.
    Deitch EA, Berg R, Specian R (1987) Endotoxin promotes the translocation of bacteria from the gut. Arch Surg 122:185–190.PubMedGoogle Scholar
  11. 11.
    Marshall JC, Christou NV, Horn R, et al. (1988) The microbiology of multiple organ failure: the proximal GI tract as an occult reservoir of pathogens. Arch Surg 123:309–315.PubMedGoogle Scholar
  12. 12.
    Meakins JL, Marshall JC (1989) The gut as the motor of multiple system organ failure. In: Marston A, Bulkley GB, Fiddian Green RG, et al. (eds) Splanchnic Ischemia and Multiple Organ Failure. CV Mosby, St Louis, pp 339–348.Google Scholar
  13. 13.
    Nelson DP, Samsel RW, Wood LD, Schumacker PT (1988) Pathologic supply dependence of systemic and intestinal O2 uptake during endotoxemia. J Appi Physiol 64:2410–2419.Google Scholar
  14. 14.
    Dahn MS, Lange P, Lobdell K, Hans B, Jacobs LA, Mitchel RA (1989) Hepatic blood flow and splanchnic oxygen consumption measurements in clinical sepsis. Surgery 107:295–301.Google Scholar
  15. 15.
    Dahn MS, Lange P, Lobdell K, Hans B, Jacobs LA, Mitchell RA (1987) Splanchnic and total body oxygen consumption differences in septic and injured patients. Surgery 101:69–80.PubMedGoogle Scholar
  16. 15.
    Lang CH, Bagby GJ, Ferguson JL, Spitzer JJ (1984) Cardiac output and redistribution of organ blood flow in hypermetabolic sepsis. Am J Physiol 246 R: 331–337.Google Scholar
  17. 17.
    Wang P, Ba ZF, Chaudry IH (1991) Hepatic extraction of indocyanine green is depressed early in sepsis despite increased hepatic blood flow and cardiac output. Arch Surg 126: 219–224.PubMedGoogle Scholar
  18. 18.
    Fong Y, Marano MA, Moldawer LL, et al. (1990) The acute splanchnic and peripheral tissue metabolic response to endotoxin in humans. J Clin Invest 85:1896–1904.PubMedCrossRefGoogle Scholar
  19. 19.
    Johnson GA, McNamara JJ (1981) Organ ischernia after hemorrhagic shock. Surg Forum 32:24–26.Google Scholar
  20. 20.
    Leevy CM, George W, Lesko W, et al. (1961) Observations on hepatic oxygen metabolism in man. JAMA 178:565–567.PubMedGoogle Scholar
  21. 21.
    Brown RS, Carey JS, Mohr PA, Monson DO, Shoemaker WC (1966) Comparative evaluation of sympathomimetic amines in clinical shock. Circulation 34:260–271.PubMedCrossRefGoogle Scholar
  22. 22.
    Sibbald WJ, Calvin JE, et al. (1983) Concepts in the pharmacologic and nonpharmacologic support of cardiovascular function in critically ill surgical patients. Surg Clin North Am 63:456–465.Google Scholar
  23. 23.
    Dhainaut JF, Edwards JD, Grootendorst AF, et al. (1990) Practical aspects of oxygen transport: conclusions and recommendations of the Round Table Conference. Int Care Med 16: 179–180.CrossRefGoogle Scholar
  24. 24.
    Reinhart K, Hannemann L, Kuss B (1990) Optimal levels of O2 delivery in the critically ill. Int Care Med 16:149–154.CrossRefGoogle Scholar
  25. 25.
    Shoemaker WC, Appel PL, Kram HB, Bishop M, Abraham E (1993) Hemodynamic and oxygen transport monitoring to titrate therapy in septic shock. New Horizons 1: 145–159.PubMedGoogle Scholar
  26. 26.
    Shoemaker WC, Appel PL, Kram HB, Duarte D, Harrier D, Ocampo HA (1989) Comparison of hemodynamic and oxygen transport effects of dopamine and dobutamine in critically ill surgical patients. Chest 96:120–126.PubMedCrossRefGoogle Scholar
  27. 27.
    Vincent JL, Van der Linden P, Domb M, Blecic S, Azimi G, Bernard A (1987) Dopamine compared with dobutamine in experimental septic shock: Relevance to fluid administration. Anesth Analg 66:565–571.PubMedCrossRefGoogle Scholar
  28. 28.
    Vincent JL, Roman A, Kahn RJ (1990) Dobutamine administration in septic shock: Addition to a standard protocol. Crit Care Med 18:689–693.PubMedCrossRefGoogle Scholar
  29. 29.
    Silverman HJ, Tuma P (1992) Gastric tonometry in patients with sepsis. Effects of dobutamine infusions and packed red blood cell transfusions. Chest 102:184–188.Google Scholar
  30. 30.
    Schneider AJ, Groeneveld ABJ, Teule GJJ, Nauta J, Heidendal GAK, Thijs LG (1987) Volume expansion, dobutamine and noradrenaline for treatment of right ventrikular dysfunction in porcine septic shock: A combined invasive and radionuclide study. Circ Shock 23: 93–106.PubMedGoogle Scholar
  31. 31.
    Leier CV (1988) Regional blood flow responses to vasodilators and inotropes in congestive heart failure. Am J Cardiol 62:86E–93E.PubMedCrossRefGoogle Scholar
  32. 32.
    Mousdale S, Clyburn PA, Mackie AM, Groves ND, Rosen M (1988) Comparison of the effects of dopamine, dobutamine, and dopexamine upon renal blood flow: a study in normal healthy volunteers. Br J Clin Pharmac 25:555–560.Google Scholar
  33. 33.
    Hayes MA, Timmins AC, Yau EHS, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J- Med 330: 1717–1722.PubMedCrossRefGoogle Scholar
  34. 34.
    Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supra-normal values of survivors as therapeutic goals in high risk surgical patients. Chest 94: 1176–1186.PubMedCrossRefGoogle Scholar
  35. 35.
    Bland RD, Shoemaker WC, Abraham E, Cobo JC (1995) Hemodynamic and oxygen transport patterns in surviving and nonsurviving postoperative patients. Crit Care Med 13: 85–90.CrossRefGoogle Scholar
  36. 36.
    Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supra-normal values of survivors as therapeutic goals in high risk surgical patients. Chest 94: 1176–1186.PubMedCrossRefGoogle Scholar
  37. 37.
    Gutierrez G, Clark C, Brown SD, Price K, Ortiz L, Nelson C (1994) Effect of dobutamine on oxygen consumption and gastric mucosal pH in septic patients. Am J Respir Crit Care Med 150:324–329.PubMedGoogle Scholar
  38. 38.
    Granger DN, Richardson PDI, Kvietys PR, Mortillaro NA (1980) Intestinal blood flow. Gastroenterology 78:837–863.PubMedGoogle Scholar
  39. 39.
    Giraud GD, MacCannell KL (1984) Decreased nutrient blood flow during dopamine- and epinephrine-induced intestinal vasodilatation. J Pharm Exp Ther 230:214–220.Google Scholar
  40. 40.
    Reilly FD, McCuskey RS, v Cilento E (1981) Hepatic microvascular regulatory mechanisms. I. Adrenergic mechanisms. Microvasc Res 21:103–116.CrossRefGoogle Scholar
  41. 41.
    Mills LC, Moyer JH, Handley CA (1960) Effects of various sympathicomimetic drugs on renal hemodynamics in normotensive and hypotensive dogs. Am J Physiol 198:1279.PubMedGoogle Scholar
  42. 42.
    Shoemaker WC, Appel PL, Kram HB (1991) Oxygen transport measurements to evaluate tissue perfusion and titrate therapy: Dobutamine and dopamine effects. Crit Care Med 19: 672–688.PubMedCrossRefGoogle Scholar
  43. 43.
    Melchior JC, Pinaud M, Blanloeil Y, Bourreli B, Potei G, Souron R (1987) Hemodynamic effects of continious norepinephrine infusion in dog with and without hyperkinetic endotox-ic shock. Crit Care Med 15:687–691.PubMedCrossRefGoogle Scholar
  44. 44.
    Bakker J, Vincent JL (1993) Effects of norepinephrine and dobutamine on oxygen transport and consumption in a dog model of endotoxic shock. Crit Care Med 21:425–432.PubMedCrossRefGoogle Scholar
  45. 45.
    Schreuder WO, Schneider AJ, Groeneveld ABJ, Thijs LG (1989) Effect of dopamine vs norepinephrine on hemodynamics in septic shock. Emphasis on right ventricular performance. Chest 95:1282–1288.Google Scholar
  46. 46.
    Meadows D, Edwards JD, Wilkins RG, Nightingale P (1988) Reversal of intractable septic shock with norepinephrine therapy. Crit Care Med 16:663–666.PubMedCrossRefGoogle Scholar
  47. 47.
    Specht M, Meier-Hellmann A, Hannemann L, Spies C, Wirbelauer Ch, Heil Th, Reinhart K (1993) Effects of dobutamine vs norepinephrine therapy on oxygen supply and oxygen consumption in septic patients. Crit Care Med 21: S276.CrossRefGoogle Scholar
  48. 48.
    Desjars P, Pinaud M, Potel G, Tasseau F, Touze MD (1987) A reappraisal of norepinephrine in human septic shock. Crit Care Med 15:134–137.PubMedCrossRefGoogle Scholar
  49. 49.
    Hesselvik JF, Brodin B (1989) Low dose norepinephrine in patients with septic shock and oliguria: Effects on afterload, urine flow, and oxygen transport. Crit Care Med 17:179–180.PubMedCrossRefGoogle Scholar
  50. 50.
    Martin C, Eon B, Saux P, Aknin P, Gouin F (1990) Renal effects of norepinephrine used to treat septic shock patients. Crit Care Med 18:282–285.CrossRefGoogle Scholar
  51. 51.
    Redl-Wenzl EM, Armbruster C, Edelmann G, Fischi E, Kolacny M, Wechsler-Födös A, Sporn P (1993) The effects of norepinephrine on hemodynamics and renal function in severe septic shock states. Intensive Care Med 19:151–154.PubMedCrossRefGoogle Scholar
  52. 52.
    Fukuoka T, Nishimura M, Imanaka H, Taenaka N, Yoshiya I, Takezawa J (1989) Effects of norepinephrine on renal function in septic patients with normal and elevated lactate levels. Crit Care Med 17:1104–1107.PubMedCrossRefGoogle Scholar
  53. 53.
    Bersten AD, Hersch M, Cheung H, Rutledge FS, Sibbald WJ (1992) The effect of various sympathomimetics on the regional circulations in hyperdynamic sepsis. Surgery 112:549–561.PubMedGoogle Scholar
  54. 54.
    Baker CH, Wilmoth FR (1984) Microvascular responses to E. Coli endotoxin with altered adrenergic activity. Circ Shock 12:165–176.Google Scholar
  55. 55.
    Gray GA, Furman BL, Parratt JR (1990) Endotoxin-induced impairment of vascular reactivity in the pithed rat: Role of arachidonic acid metabolites. Circ Shock 31:395–406.PubMedGoogle Scholar
  56. 56.
    Hollenberg SM, Cunnion RE, Parrillo JE (1992) Effect of septic serum on vascular smooth muscle: In vitro studies using rat aortic rings. Crit Care Med 20:993–998.PubMedCrossRefGoogle Scholar
  57. 57.
    Kato T, Hayashi K, Takamizawa K (1988) Response of femoral arteries to norepinephrine following endotoxicosis. Circ Shock 26:383–390.PubMedGoogle Scholar
  58. 58.
    Seaman KL, Greenway CV (1984) Loss of hepatic venous responsiveness after endotoxin in anesthetized cats. Am J Physiol 246:H658–H663.PubMedGoogle Scholar
  59. 59.
    Breslow MJ, Miller CF, Parker SD, Walman AT, Traystman RJ (1987) Effect of vasopressors on organ blood flow during endotoxin shock in pigs. Am J Physiol 252:H291–H300.PubMedGoogle Scholar
  60. 60.
    Marik PE, Mohedin M (1994) The contrasting effects of dopamine and norepinephrine on systemic and splanchnic oxygen utilization in hyperdynamic sepsis. JAMA 272:1354–1357.PubMedCrossRefGoogle Scholar
  61. 61.
    Bollaert PE, Bauer Ph, Audibert G, Lambert H, Larcan A (1990) Effects of epinephrine on hemodynamics and oxygen metabolism in dopamine-resistant septic shock. Chest 98:949–953.PubMedCrossRefGoogle Scholar
  62. 62.
    Lipman J, Roux A, Kraus P (1991) Vasoconstrictor Effects of Adrenaline in Human Septic Shock. Anaesth Intens Care 19:61–65.Google Scholar
  63. 63.
    Mackenzie SJ, Kapadia F, Nimmo GR, Armstrong IR, Grant IS (1991) Adrenaline in treatment of septic shock: effects on hemodynamics and oxygen transport. Intensive Care Med 17:36–39.PubMedCrossRefGoogle Scholar
  64. 64.
    Innes IR, Nickerson M (1975) Norepinephrine, epinephrine and the sympathomimetic amines. In: Goodman LD, Gilman A (eds) The Pharmalogical Basis of Therapeutics. Mac-Millan, New York, pp 483–504.Google Scholar
  65. 65.
    Moran JL, O’Fathartaigh MS, Peisach AR, Chapman MJ, Leppard Ph (1993) Epinephrine as an inotropic agent in septic shock: A dose-profile analysis. Crit Care Med 21:70–77.PubMedCrossRefGoogle Scholar
  66. 66.
    Haddy FJ, Chou CC, Scott JB, et al. (1967) Intestinal vascular responses to naturally occurring vasoactive substances. Gastroenterology 52:444–451.PubMedGoogle Scholar
  67. 67.
    Haddy FJ, Molnar JI, Borden CW, et al. (1962) Comparison of direct effects of angiotensin, and other vasoactive agents on small and large blood vessels in several vascular beds. Circulation 25:239–246.PubMedGoogle Scholar
  68. 68.
    Pawlik W, Shepherd AP, Jacobson ED (1975) Effects of vasoactive agents on intestinal oxygen consumption and blood flow in dogs. J Clin Invest 56:484–490.PubMedCrossRefGoogle Scholar
  69. 69.
    Greenway CV, Lawson A (1966) The effects of adrenaline and noradrenaline on venous return and regional blood flow in the anesthetized cat with special reference to intestinal blood flow. J Physiol (Lond) 187:579–595.Google Scholar
  70. 70.
    Meier-Hellmann A, Hannemann L, Specht M, Schaffartzik W, Spies C, Reinhart K (1994) The relationship between mixed venous and hepatic venous O2 saturation in patients with septic shock. In: Oxygen transport to tissues XV. Vaupel P (ed) Adv Exp Med Biol 345:701–707.Google Scholar
  71. 71.
    Dahn MS, Lange P, Jacobs LA (1988) Central mixed and splanchnic venous oxygen saturation monitoring. Int Care Med 14:373–378.CrossRefGoogle Scholar
  72. 72.
    Kainuma M, Fujiwara Y, Kimura N, Shitaokoshi A, Nakashima K, Shimado Y (1991) Monitoring hepatic venous hemoglobin oxygen saturation in patients undergoing liver surgery. Anesthesiology 74:49–52.PubMedCrossRefGoogle Scholar
  73. 73.
    Meier-Hellmann A, Reinhart K, Bredle DL, et al. (in press) Epinephrine impairs splanchnic perfusion in septic shock. Crit Care Med.Google Scholar
  74. 74.
    Goldberg LI (1972) Cardiovascular and renal actions of dopamine. Potential clinical applications. Pharmacol Rev 24:1–29.Google Scholar
  75. 75.
    Vincent JL, Preiser JC (1993) Inotropic agents. New Horizons 1:137–144.PubMedGoogle Scholar
  76. 76.
    Nakatani T, Ishikawa Y, et al. (1991) Hepatic mitochondrial redox state in hypotensive brain-dead patients and an effect of dopamine administration. Int Care Med 17:103–107.CrossRefGoogle Scholar
  77. 77.
    Lundberg J, Lundberg D, Norgren L, Ribbe E, Thörne J, Werner O (1990) Intestinal Hemodynamics during Laparotomy: Effects of Thoracic Epidural Anesthesia and Dopamine in Humans. Anesth Analg 71:9–15.PubMedCrossRefGoogle Scholar
  78. 78.
    Winsö O, Biber B, Martner J (1985) Does Dopamine Suppress Stress-Induced Intestinal and Renal Vasoconstriction? Acta Anaesthesiol Scand 29:508–514.PubMedCrossRefGoogle Scholar
  79. 79.
    Duke GJ, Briedis JH, Weaver RA (1994) Renal support in critically ill patients: Low dose dopamine or low dose dobutamine. Crit Care Med 22:1919–1925.PubMedGoogle Scholar
  80. 80.
    Johnson DJ, Johannigman JA, Branson RD, Davis K, Hurst JM (1991) The Effect of Low Dose Dopamine on Gut Hemodynamics during PEEP Ventilation for Acute Lung Injury. J Surg Research 50:344–349.CrossRefGoogle Scholar
  81. 81.
    Townsend MC, Schirmer WJ, Schirmer JM, Fry DE (1987) Low-dose dopamine improves effective hepatic blood flow in murine peritonitis. Circ Shock 21:149–153.PubMedGoogle Scholar
  82. 82.
    Pawlik W, Shepherd AP, Mailman D, Shanbour LL, Jacobson ED (1976) Effects of dopamine and epinephrine on intestinal blood flow and oxygen uptake. In: Grote J, Reneau D, Thews G (eds) Oxygen transport to the tissue — II. Plenum Press, New York London, pp 511–516.Google Scholar
  83. 83.
    Kullrnann R, Breull WR, Reinsberg J, Wassermann K, Konopatzki A (1983) Dopamine produces vasodilation in specific regions and layers of the rabbit gastrointestinal tract. Life Sciences 32:2115–2122.CrossRefGoogle Scholar
  84. 84.
    Roytblat L, Gelman S, Bradley EL, Henderson T, Parks D (1990) Dopamine and hepatic oxygen supply-demand relationship. Can J Physiol Pharmacol 1165–1169.Google Scholar
  85. 85.
    Jackson LK, Key BM, Cain SM (1982) Total and hindlimb O2 uptake and blood flow in hypoxic dogs given dopamine. Crit Care Med 10:327–331.PubMedCrossRefGoogle Scholar
  86. 86.
    Regan CJ, Duckworth R, Fairhurst JA, Maycock PF, Frayn KN, Campbell IT (1990) Metabolic effects of low-dose dopamine infusion in normal volunters. Clin Science 79:605–611.Google Scholar
  87. 87.
    Ruttimann Y, Chidero R, et al. (1989) Effects of dopamine on total oxygen consumption and oxygen delivery in healthy men. Am J Physiol 257:E541–546.PubMedGoogle Scholar
  88. 88.
    Meier-Hellmann A, Reinhart K, Bredle DL, Specht M, Spies C, Hannemann L, Heiss-Dunlop W (1996) The effects of low-dose dopamine on splanchnic perfusion and oxygen uptake in patients with septic shock. Intensive Care Med (in press).Google Scholar
  89. 89.
    Baumann G, Gutting M, Pfafferott C, Ningel K, Klein G (1988) Comparison of acute haemodynamic effects of dopexamine hydrochloride, dobutamine and sodium nitroprusside in chronic heart failure. Eur Heart J 9:503–512.PubMedGoogle Scholar
  90. 90.
    De Marco T, Kwasman M, Au D, Chatterjee K (1988) Dopexamine Hydrochloride in chronic congestive heart failure with improved cardiac performance without increased metabolic cost. Am J Cardiol 62:57C–62C.PubMedCrossRefGoogle Scholar
  91. 91.
    Parratt JR, Wainwright CL, Fagbemi O (1988) Effect of dopexamine hydrochloride in the early stages of experimental myocardial infarction and comparison with dopamine and dobutamine. Am J Cardiol 62:18C–23C.PubMedCrossRefGoogle Scholar
  92. 92.
    Svenson G, Strandberg LE, Lindvall B, Erhardt L (1988) Haemodynamic response to dopexamine hydrochloride in postinfarction heart failure: lack of tolerance after continuous infusion. Br Heart J 60:489–496.PubMedCrossRefGoogle Scholar
  93. 93.
    Tan LB, Littler A, Murray RG (1987) Beneficial haemodynamic effects of intravenous dopexamine in patients with low-output heart failue. J Cardiovasc Pharmacol 10:280–286.PubMedCrossRefGoogle Scholar
  94. 94.
    Colardyn FC, Vandenbogaerde JF, Vogelaers DP, Verbeke JH (1989) Use of dopexamine hydrochloride in patients with septic shock. Crit Care Med 17:999–1003.PubMedCrossRefGoogle Scholar
  95. 95.
    Cain SM, Curtis SE (1991) Systemic and regional oxygen uptake and delivery and lactate flux in endotoxic dogs infused with dopexamine. Crit Care Med 19:1552–1560.PubMedCrossRefGoogle Scholar
  96. 96.
    Biro GP, Douglas JR, Keon WJ, Taichman GC (1988) Changes in regional blood flow distribution induced by infusions of dopexamine hydrochloride or dobutamine in anesthetized dogs. Am J Cardiol 62:30C–36C.PubMedCrossRefGoogle Scholar
  97. 98.
    Lokhandwala MF, Jandhyala BS (1992) Effects of dopaminergic agonists on organ blood flow and function. Clin Int Care 3(1) (Suppl):12–16.Google Scholar
  98. 98.
    Uusaro A, Ruokonen E, Takala J (1995) Gastric mucosal pH does not reflect changes in splanchnic blood flow after cardiac surgery. Br J Anaesth 74:149–154.PubMedCrossRefGoogle Scholar
  99. 99.
    Smithies M, Yee TH, Jackson L, Beale R, Binari D (1994) Protecting the gut and the liver in the critically ill: Effects of dopexamine. Crit Care Med 22:789–795.PubMedCrossRefGoogle Scholar
  100. 100.
    Boyd O, Grounds RM, Bennett ED (1993) A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 270:2699–2707.PubMedCrossRefGoogle Scholar
  101. 101.
    Baumann G, Felix SB, Filcek SAL (1990) Usefulness of dopexamine hydrochloride versus dobutamine in chronic congestive heart failure and effects on hemodynamics and urine output. Am J Cardiol 65:748–754.PubMedCrossRefGoogle Scholar
  102. 102.
    Gray PA, Bodenham AR, Park GR (1991) A comparison of dopexamine and dopamine to prevent renal impairment in patients undergoing orthotopic liver transplantation. Anaesthesia 46:638–641.PubMedCrossRefGoogle Scholar
  103. 103.
    Stephan H, Sonntag H, Henning H, Yoshimine K (1990) Cardiovascular and renal haemodynamic effects of dopexamine: comparison with dopamine. Brit J Anaesth 65:380–387.PubMedCrossRefGoogle Scholar
  104. 104.
    Magrini F, Foulds RA, Roberts N, Macchi G, Mondadori C, Zanchetti A (1988) Renal hemodynamic effects of dopexamine hydrochloride. Am J Cardiol 62:53C–56C.CrossRefGoogle Scholar
  105. 105.
    Shoemaker WC, Appel PL, Kram HB (1988) Tissue oxygen debt as a determinant of lethal and nonlethal postoperative organ failure. Crit Care Med 16:117–120.CrossRefGoogle Scholar
  106. 106.
    Tuchschmidt J, Fried J, Swinney R, et al. (1989) Early hemodynamic correlations of survival in patients with septic shock. Crit Care Med 17:719–723.PubMedCrossRefGoogle Scholar
  107. 107.
    Hannemann L, Meier-Hellmann A, Specht M, Spies C, Reinhart K (1993) O2-Angebot, O2-Verbrauch und Mucosa pH-Wert des Magens. Anaesthesist 42:11–14.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • A. Meier-Hellmann
  • K. Reinhart

There are no affiliations available

Personalised recommendations