Dobutamine-induced dissociation between changes in splanchnic blood flow and gastric intramucosal pH after cardiac surgery
Open Access
- 1 March 1995
- journal article
- clinical trial
- Published by Elsevier in British Journal of Anaesthesia
- Vol. 74 (3) , 277-282
- https://doi.org/10.1093/bja/74.3.277
Abstract
Gastric intramucosal acidosis, a sign of splanchnic tissue hypoxia, is common after cardiac surgery. We tested the hypothesis that an increase in splanchnic blood flow induced by dobutamine improves splanchnic tissue oxygenation after cardiac surgery. We measured changes in gastric intramucosal pH, splanchnic blood flow and oxygen transport in response to increased systemic flow induced by dobutamine (mean 4.4 (range 3.0–7.0) µg kg−1 min−1) after coronary artery bypass. We studied 22 stable postoperative patients who were allocated randomly to receive dobutamine (n = 11) or to serve as controls (n = 11). Dobutamine was given also to a separate group with a low cardiac index after operation (n = 6). The end-point was to increase cardiac index by at least 25% and to exceed 2 litre min−1 m−2. Dobutamine consistently increased mean splanchnic blood flow (control 0.6 (SD0.2) vs 0.7 (0.2) litre min−1 m−2 (Pvs 1.1 (0.4) litre min−1 m−2 (Pvs 0.7 (0.1) litre min−1 m−2 (Pvs 111 (28) ml min−1 m−2 (ns); normal cardiac output and dobutamine 106 (27) vs 156 (47) ml min−1 m−2 (P < 0.01); low cardiac output and dobutamine 75 (21) vs 110 (26) ml min−1 m−2 (Pvs 49 (10) ml min−1 m−2 (ns); normal cardiac output and dobutamine 45(12) vs 51 (17) ml min−1 m−2 (ns); low cardiac output and dobutamine 37 (9) vs 40 (9) ml min−1 m−2 (ns)). Despite this, dobutamine reduced gastric intramucosal pH in all patients with low cardiac output (7.33 (0.12) vs 7.25(0.06) (Pvs 7.34(0.06) (ns)). In contrast, gastric intramucosal pH remained stable in the control group (7.34 (0.05) vs 7.34 (0.04) (ns)).We conclude that dobutamine resulted in a dissociation between splanchnic oxygen delivery and gastric mucosal tissue oxygenation, suggesting inappropriate distribution of blood flow within the splanchnic region. (Br. J. Anaesth. 1995; 74: 277–282)Keywords
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