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Jukka Takala - One of the best experts on this subject based on the ideXlab platform.
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assessment of Splanchnic Blood Flow using magnetic resonance imaging
European Journal of Gastroenterology & Hepatology, 2009Co-Authors: Daniel Barthelmes, Jukka Takala, Ilkka Parviainen, Pauli Vainio, Ritva Vanninen, Aki Ikonen, David Tueller, Stephan M JakobAbstract:BACKGROUND AND AIMS: The Splanchnic circulation has an important function in the body under both physiological and pathophysiological conditions. Despite its importance, no reliable noninvasive procedures for estimating Splanchnic circulation have been established. The aim of this study was to evaluate MRI as a tool for assessing intra-abdominal Blood Flows of the aorta, portal vein (VPO) and the major intestinal and hepatic vessels. METHODS: In nine healthy volunteers, the proximal aorta (AOP) and distal abdominal aorta (AOD), superior mesenteric artery (SAM), celiac trunk (CTR), hepatic arteries (common and proper hepatic arteries, AHC and AHP, respectively), and VPO were localized on contrast-enhanced magnetic resonance angiography images. Volumetric Flow was measured using a two-dimensional cine echocardiogram-gated phase contrast technique. Measurements were taken before and 30 min after continuous intravenous infusion of somatostatin (250 microg/h) and were independently evaluated by two investigators. RESULTS: Blood Flow measured by MRI in the VPO, SAM, AOP, AHP, and CTR significantly decreased after drug infusion. Flows in the AOD and AHC showed a tendency to decrease (P>0.05). Interrater agreement on Flows in MRI was very good for large vessels (VPO, AOP, and AOD), with a concordance correlation coefficient of 0.94, as well as for smaller vessels such as the CTR, AHC, AHP, and SAM (concordance correlation coefficient =0.78). CONCLUSION: Somatostatin-induced Blood Flow changes in the Splanchnic region were reliably detected by MRI. MRI may be useful for the noninvasive assessment of Blood Flow changes in the Splanchnic region.
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effect of dopamine induced changes in Splanchnic Blood Flow on megx production from lidocaine in septic and cardiac surgery patients
Shock, 2002Co-Authors: Stephan M Jakob, Esko Ruokonen, Per H Rosenberg, Jukka TakalaAbstract:The production of monoethylglycine xylidide (MEGX) from lidocaine is thought to be dependent on hepatic Blood Flow. We assessed the relationship between hepatoSplanchnic Blood Flow, lidocaine uptake, and the production of MEGX from lidocaine in seven patients after cardiac surgery and in nine septic patients. Systemic (pulmonary artery catheter) and Splanchnic (hepatic vein catheter and dye dilution) hemodynamics and arterial and hepatic venous lidocaine and MEGX concentrations were measured after a lidocaine bolus injection (1 mg/kg) before and 90 min after increasing cardiac output by at least 25% with dopamine. Dopamine infusion [in cardiac surgery patients 4.2 (1.4-8.5) microg x kg(-1) x min(-1) (median, range) and in septic patients 4.0 (2.1-9.0) microg x kg(-1) x min(-1)] increased Splanchnic Blood Flow in cardiac surgery patients from 0.65 (0.12) L x min(-1) x m(-2) to 0.84 (0.14) L x min(-1) x m(-2) mean (standard deviation) P = 0.018) and in septic patients from 0.91 (0.32) L x min(-1) x m(-2) to 1.12 (0.40) L x min(-1) x m(-2) (P = 0.038). Splanchnic MEGX production for the 30 min after lidocaine injection was higher in cardiac surgery patients than in septic patients both at baseline [4130 (1100) microg x m(-2) vs. 930 (420) microg x m(-2) (P < 0.005)] and afterdopamine infusion [4480 (1000) microg x m(-2) vs. 1090 (620) microg x m(-2) (P = 0.005)]. We found no correlation between changes in MEGX production and changes in Splanchnic Blood Flow. Patients with sepsis have severe impairment of cytochrome P450-dependent liver function, which is not influenced by acute changes in hepatoSplanchnic Blood Flow. MEGX production cannot be used as an estimate of changes in Splanchnic Blood Flow.
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variability of Splanchnic Blood Flow measurements in patients with sepsis physiology pathophysiology or measurement errors
Intensive Care Medicine, 2001Co-Authors: S M Jakob, Jukka TakalaAbstract:Impaired tissue oxygenation, especially in the Splanchnic region, may play a central role both in the pathogenesis of multiple organ dysfunction and in the development of complications in various groups of intensive care patients [1, 2]. In severe inflammation such as SIRS, septic infection, and septic shock, the metabolic demand for oxygen in the Splanchnic region is increase [3, 4, 5]. This is explanied in part by and increased hepatic metabolism [6, 7]. In patients with normal or hyperdynamic hemodynamics, but the increase in oxygen consumption is disproportionate to the increase in Blood Flow.
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jejunal and gastric mucosal perfusion versus Splanchnic Blood Flow and metabolism an observational study on postcardiac surgical patients
Critical Care Medicine, 2000Co-Authors: Anders Thoren, Stephan M Jakob, Richard Pradl, Mikael Elam, Svenerik Ricksten, Jukka TakalaAbstract:Objectives: To evaluate the association between changes in total Splanchnic and mucosal perfusion, assessed either by gastric tonometry or jejunal laser Doppler Flowmetry in postcardiac surgical patients. Design: A prospective, observational study. Settings: A general intensive care unit in a tertiary care center. Patients: Twelve, postoperative cardiac surgery patients were studied. Interventions: Patients were treated according to clinical routine. Total Splanchnic Blood Flow (indocyanine green extraction), jejunal mucosal perfusion (laser Doppler Flowmetry), gastric mucosal-arterial PCO 2 gradients, and Splanchnic lactate uptake were studied during four 30-min measurements periods, each separated by a period of 1 hr. Measurements and Main Results: There was no consistent association between either total Splanchnic and local mucosal perfusion or between gastric and jejunal perfusion as assessed by two different techniques. The PCO 2 gradient increased from 0.73 ± 0.21 kPa to 1.15 ± 0.30 kPa (p <.05), and Splanchnic oxygen extraction increased from 40% ± 9% to 49% ± 14% (p <.01). Conclusions: In this observational study on postcardiac surgical patients, local mucosal perfusion did not reflect total Splanchnic Blood Flow and vice versa. Either changes in gastric and jejunal mucosal perfusion were different or increasing tissue metabolism was responsible for the observed lack of association between tonometry, laser Doppler Flowmetry, and total Splanchnic Blood Flow. Increasing mucosal arterial PCO 2 gradient and Splanchnic oxygen extraction may reflect a mismatch between Splanchnic perfusion and metabolic demands.
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the effect of dobutamine infusion on Splanchnic Blood Flow and oxygen transport in patients with acute pancreatitis
Intensive Care Medicine, 1997Co-Authors: Esko Ruokonen, Ari Uusaro, E Alhava, Jukka TakalaAbstract:Objectives: To measure the Blood Flow distribution and oxygen transport in pancreatitis and to evaluate the regional effects of increased systemic Blood Flow. Design: Nonrandomized controlled trial. Setting: A general intensive care unit in a tertiary care center. Patients: 10 patients with pancreatitis requiring mechanical ventilation were studied after fluid resuscitation, and for the response to dobutamine, the patients served as their own controls. For the baseline, 11 patients scheduled for elective abdominal surgery served as a control group. Interventions: Systemic and regional hemodynamics were measured after fluid resuscitation to predefined hemodynamic endpoints. In patients with pancreatitis, the measurement was repeated after cardiac output had been increased by at least 25 % by dobutamine. Measurements and results: HepatoSplanchnic Blood Flow was estimated using regional catheterization and the dye dilution method. In patients with pancreatitis, the cardiac index did not differ from that of the control group (3.9 ± 0.8 vs 4.1 ± 0.7 l · min–1· m–2;NS). Accordingly, there was no difference in the Splanchnic Blood Flow (1.1 ± 0.4 vs 1.2 ± 0.5 l · 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 vs23 ± 0.05, p < 0.01 and 0.46 ± 0.18 vs 0.28 ± 0.08, p < 0.05, respectively). Dobutamine had inconsistent effects on Splanchnic Blood Flow: in individual patients, Splanchnic Blood Flow even decreased substantially. 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 Flow with dobutamine does not improve perfusion in the Splanchnic bed.
Andreas Meierhellmann - One of the best experts on this subject based on the ideXlab platform.
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variability of Splanchnic Blood Flow in patients with sepsis
Intensive Care Medicine, 2001Co-Authors: Samir G Sakka, Konrad Reinhart, Karl Wegscheider, Andreas MeierhellmannAbstract:Objectives: Previous studies on therapeutic interventions in sepsis have assumed stability of the measure of Splanchnic Blood Flow throughout the study. We assessed the variability of Splanchnic Blood Flow during stable global hemodynamics in eight patients with sepsis requiring treatment with dobutamine and/or norepinephrine. Design and setting: Prospective clinical study in an intensive care unit of a university hospital. Measurements and results: Global and regional hemodynamics were measured at baseline, 2 h later, and 4 h later. Cardiac output was measured by transpulmonary thermodilution, intrathoracic Blood volume as an indicator of cardiac preload, and total Blood volume by the double indicator (thermo-dye) dilution technique. Total body oxygen consumption was assessed by indirect calorimetry using a metabolic cart. Splanchnic Blood Flow was measured by the continuous indocyanine green method, and gastric mucosal CO2 tension by gas tonometry. Neither absolute nor fractional Splanchnic Blood Flow (as ratio of cardiac output) revealed significant global tendencies during the study period. However, variance component analysis showed that Splanchnic Blood Flow determinations varied considerably within patients, for repeated measurements at 5-min intervals (standard error 31.1%) as well as for average values at 2-h intervals (25.6%). Conclusion: Stable global hemodynamics during a 4-h period in septic patients does not exclude marked changes in Splanchnic Blood measured by a hepatic venous catheter technique.
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does the optimization of cardiac output by fluid loading increase Splanchnic Blood Flow
BJA: British Journal of Anaesthesia, 2001Co-Authors: Samir G Sakka, Konrad Reinhart, Andreas MeierhellmannAbstract:We studied the effects of increasing cardiac output by fluid loading on Splanchnic Blood Flow in patients with haemodynamically stabilized septic shock. Eight patients (five female, 39–86 yr) were assessed using a transpulmonary thermo-dye-dilution technique for the measurement of cardiac index (CI) intrathoracic Blood volume (ITBV) as a marker of cardiac preload and total Blood volume (TBV). Splanchnic Blood Flow was measured by the steady state indocyanine-green technique using a hepatic venous catheter. Gastric mucosal Blood Flow was estimated by regional carbon dioxide tension (P r CO2). Hydroxyethyl starch was infused to increase cardiac output while mean arterial pressure was kept constant. In parallel, mean norepinephrine dosage could be reduced from 0.59 to 0.33 µg kg–1 min–1. Mean ( sd ) TBV index increased from 2549 (365) to 3125 (447) ml m–2, as did ITBV index from 888 (167) to 1075 (266) ml m–2 and CI from 3.6 (1.0) to 4.6 (1.0) litre min–1 m–2. Despite marked individual differences, Splanchnic Blood Flow did not change significantly neither absolutely (from 1.09 (0.96) to 1.19 (0.91) litre min–1 m–2) nor fractionally as part of CI (from 28.4 (19.5) to 24.9 (16.3)%). Gastric mucosal P r CO2 increased from 7.7 (2.6) to 8.3 (3.1) kPa. The P co 2-gap, the difference between regional and end-tidal P co 2, increased slightly from 3.2 (2.7) to 3.4 (3.1) kPa. Thus, an increase in cardiac output as a result of fluid loading is not necessarily associated with an increase in Splanchnic Blood Flow in patients with stabilized septic shock.
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n acetylcysteine increases liver Blood Flow and improves liver function in septic shock patients results of a prospective randomized double blind study
Critical Care Medicine, 2000Co-Authors: Nikolaus Rank, Andreas Meierhellmann, Christian Michel, Corina Haertel, Andreas Lenhart, M Welte, Claudia SpiesAbstract:ObjectiveIn septic shock, decreased Splanchnic Blood Flow is reported, despite adequate systemic hemodynamics. N-acetylcysteine (NAC) was found to increase hepatoSplanchnic Blood Flow in experimental settings. In septic shock patients, NAC improved the clearance of indocyanine green and the relation
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dopexamine increases Splanchnic Blood Flow but decreases gastric mucosal ph in severe septic patients treated with dobutamine
Critical Care Medicine, 1999Co-Authors: Andreas Meierhellmann, Donald L. Bredle, Martin Specht, Lutz Hannemann, Konrad ReinhartAbstract: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 ig/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 ( O2). Splanchnic Blood Flow increased proportionally to cardiac output, indicating that there was no selective effect of dopexamine on 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. Because the gut has been proposed as a genesis of multiple organ failure, much attention has been given to the adequacy of Splanchnic perfusion in patients with sepsis (1-3). It is well known that in patients with sepsis the metabolic demand in the Splanchnic region is elevated (1), and therefore, therapeutic strategies that try to increase Blood Flow to the Splanchnic area are reasonable (4). For example, low -dose dopamine has been infused with the intent to increase Splanchnic circulation and oxygenation (5, 6). Nevertheless, the common practice of many intensivists to treat septic patients with low -dose dopamine to elevate renal and Splanchnic perfusion is becoming suspect, because to date neither the prevention of renal failure (7) nor a beneficial effect on Splanchnic circulation (8) has really been proven. Moreover, Giraud and MacCannell (9) demonstrated that low -dose dopamine may induce a redistribution of Blood Flow from the gut mucosa to the gut muscularis. We found that low dose dopamine could increase Splanchnic Blood Flow in some septic patients, but in patients with an already elevated Splanchnic Blood Flow, low -dose dopamine either failed to increase or even reduced Splanchnic Flow (10). Furthermore, it is well known that prolonged dopamine infusion suppresses the circulating concentrations of pituitary-dependent hormones, which may be harmful to the already -threatened metabolic and immunologic homeostasis in critically ill patients (11-13). Because of these potential disadvantages of low -dose dopamine, the newer synthetic catecholamine dopexamine, which also has dopaminergic properties, may serve as a logical alternative. Dopexamine has a potency relative to that of dopamine as a DA -1 agonist of 0.34, as a DA -2 agonist of 0.17, and as a â-1 agonist of 0.1, but it has 60 times the â-2 agonist activity. In addition, dopexamine has no a-adrenergic receptor activity (14). When compared with dobutamine, dopexamine has less effect on cardiac â1-receptors but stronger effects on vascular â2-receptors, as well as some dopaminergic effects. Theoretically, this would give dopexamine an advantage in increasing selective regional Blood in the treatment of sepsis. Dopexamine has been advocated for hemodynamic stabilization and increasing renal and Splanchnic perfusion in patients with heart failure (15, 16), chronic renal dysfunction (17), and hypertension (18); after liver transplantation (19); and also in septic patients (20). Nevertheless, the value of dopexamine as primary or adjunct therapy to improve Splanchnic Blood Flow in septic patients is still unknown. Therefore, we investigated the effects of increasing dosages of dopexamine on global hemodynamics, Splanchnic Blood Flow, oxygen consumption ( O2), and gastric mucosal pH (pHi) in 12 patients with severe sepsis.
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the effects of low dose dopamine on Splanchnic Blood Flow and oxygen uptake in patients with septic shock
Intensive Care Medicine, 1997Co-Authors: Andreas Meierhellmann, Donald L. Bredle, Claudia Spies, L Hannemann, Michelle C Specht, Konrad ReinhartAbstract:OBJECTIVE To assess the effects of low-dose dopamine on Splanchnic Blood Flow and Splanchnic oxygen uptake in patients with septic shock. DESIGN Prospective, controlled trial. SETTING University hospital intensive care unit. PATIENTS 11 patients with septic shock, diagnosed according the criteria of the 1992 American College of Chest Physicians/Society of Critical Care Medicine consensus conference, who required treatment with norepinephrine. MEASUREMENTS AND MAIN RESULTS Systemic and Splanchnic hemodynamics and oxygen transport were measured before and during addition of low-dose dopamine (3 micrograms/kg per min). Low-dose dopamine and a marked effect on total body hemodynamics and oxygen transport. The fractional Splanchnic Flow at baseline ranged from 0.15 to 0.57. In 7 patients with a fractional Splanchnic Flow less than 0.30, low-dose dopamine increased Splanchnic Flow and Splanchnic oxygen delivery and oxygen consumption. In 4 patients with a fractional Splanchnic Flow above 0.30, low-dose dopamine did not appear to change Splanchnic Blood Flow. CONCLUSION Low-dose dopamine has a potential beneficial effect on Splanchnic Blood Flow and oxygen consumption in patients with septic shock, provided the fractional Splanchnic Flow is not already high before treatment.
Konrad Reinhart - One of the best experts on this subject based on the ideXlab platform.
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variability of Splanchnic Blood Flow in patients with sepsis
Intensive Care Medicine, 2001Co-Authors: Samir G Sakka, Konrad Reinhart, Karl Wegscheider, Andreas MeierhellmannAbstract:Objectives: Previous studies on therapeutic interventions in sepsis have assumed stability of the measure of Splanchnic Blood Flow throughout the study. We assessed the variability of Splanchnic Blood Flow during stable global hemodynamics in eight patients with sepsis requiring treatment with dobutamine and/or norepinephrine. Design and setting: Prospective clinical study in an intensive care unit of a university hospital. Measurements and results: Global and regional hemodynamics were measured at baseline, 2 h later, and 4 h later. Cardiac output was measured by transpulmonary thermodilution, intrathoracic Blood volume as an indicator of cardiac preload, and total Blood volume by the double indicator (thermo-dye) dilution technique. Total body oxygen consumption was assessed by indirect calorimetry using a metabolic cart. Splanchnic Blood Flow was measured by the continuous indocyanine green method, and gastric mucosal CO2 tension by gas tonometry. Neither absolute nor fractional Splanchnic Blood Flow (as ratio of cardiac output) revealed significant global tendencies during the study period. However, variance component analysis showed that Splanchnic Blood Flow determinations varied considerably within patients, for repeated measurements at 5-min intervals (standard error 31.1%) as well as for average values at 2-h intervals (25.6%). Conclusion: Stable global hemodynamics during a 4-h period in septic patients does not exclude marked changes in Splanchnic Blood measured by a hepatic venous catheter technique.
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does the optimization of cardiac output by fluid loading increase Splanchnic Blood Flow
BJA: British Journal of Anaesthesia, 2001Co-Authors: Samir G Sakka, Konrad Reinhart, Andreas MeierhellmannAbstract:We studied the effects of increasing cardiac output by fluid loading on Splanchnic Blood Flow in patients with haemodynamically stabilized septic shock. Eight patients (five female, 39–86 yr) were assessed using a transpulmonary thermo-dye-dilution technique for the measurement of cardiac index (CI) intrathoracic Blood volume (ITBV) as a marker of cardiac preload and total Blood volume (TBV). Splanchnic Blood Flow was measured by the steady state indocyanine-green technique using a hepatic venous catheter. Gastric mucosal Blood Flow was estimated by regional carbon dioxide tension (P r CO2). Hydroxyethyl starch was infused to increase cardiac output while mean arterial pressure was kept constant. In parallel, mean norepinephrine dosage could be reduced from 0.59 to 0.33 µg kg–1 min–1. Mean ( sd ) TBV index increased from 2549 (365) to 3125 (447) ml m–2, as did ITBV index from 888 (167) to 1075 (266) ml m–2 and CI from 3.6 (1.0) to 4.6 (1.0) litre min–1 m–2. Despite marked individual differences, Splanchnic Blood Flow did not change significantly neither absolutely (from 1.09 (0.96) to 1.19 (0.91) litre min–1 m–2) nor fractionally as part of CI (from 28.4 (19.5) to 24.9 (16.3)%). Gastric mucosal P r CO2 increased from 7.7 (2.6) to 8.3 (3.1) kPa. The P co 2-gap, the difference between regional and end-tidal P co 2, increased slightly from 3.2 (2.7) to 3.4 (3.1) kPa. Thus, an increase in cardiac output as a result of fluid loading is not necessarily associated with an increase in Splanchnic Blood Flow in patients with stabilized septic shock.
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dopexamine increases Splanchnic Blood Flow but decreases gastric mucosal ph in severe septic patients treated with dobutamine
Critical Care Medicine, 1999Co-Authors: Andreas Meierhellmann, Donald L. Bredle, Martin Specht, Lutz Hannemann, Konrad ReinhartAbstract: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 ig/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 ( O2). Splanchnic Blood Flow increased proportionally to cardiac output, indicating that there was no selective effect of dopexamine on 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. Because the gut has been proposed as a genesis of multiple organ failure, much attention has been given to the adequacy of Splanchnic perfusion in patients with sepsis (1-3). It is well known that in patients with sepsis the metabolic demand in the Splanchnic region is elevated (1), and therefore, therapeutic strategies that try to increase Blood Flow to the Splanchnic area are reasonable (4). For example, low -dose dopamine has been infused with the intent to increase Splanchnic circulation and oxygenation (5, 6). Nevertheless, the common practice of many intensivists to treat septic patients with low -dose dopamine to elevate renal and Splanchnic perfusion is becoming suspect, because to date neither the prevention of renal failure (7) nor a beneficial effect on Splanchnic circulation (8) has really been proven. Moreover, Giraud and MacCannell (9) demonstrated that low -dose dopamine may induce a redistribution of Blood Flow from the gut mucosa to the gut muscularis. We found that low dose dopamine could increase Splanchnic Blood Flow in some septic patients, but in patients with an already elevated Splanchnic Blood Flow, low -dose dopamine either failed to increase or even reduced Splanchnic Flow (10). Furthermore, it is well known that prolonged dopamine infusion suppresses the circulating concentrations of pituitary-dependent hormones, which may be harmful to the already -threatened metabolic and immunologic homeostasis in critically ill patients (11-13). Because of these potential disadvantages of low -dose dopamine, the newer synthetic catecholamine dopexamine, which also has dopaminergic properties, may serve as a logical alternative. Dopexamine has a potency relative to that of dopamine as a DA -1 agonist of 0.34, as a DA -2 agonist of 0.17, and as a â-1 agonist of 0.1, but it has 60 times the â-2 agonist activity. In addition, dopexamine has no a-adrenergic receptor activity (14). When compared with dobutamine, dopexamine has less effect on cardiac â1-receptors but stronger effects on vascular â2-receptors, as well as some dopaminergic effects. Theoretically, this would give dopexamine an advantage in increasing selective regional Blood in the treatment of sepsis. Dopexamine has been advocated for hemodynamic stabilization and increasing renal and Splanchnic perfusion in patients with heart failure (15, 16), chronic renal dysfunction (17), and hypertension (18); after liver transplantation (19); and also in septic patients (20). Nevertheless, the value of dopexamine as primary or adjunct therapy to improve Splanchnic Blood Flow in septic patients is still unknown. Therefore, we investigated the effects of increasing dosages of dopexamine on global hemodynamics, Splanchnic Blood Flow, oxygen consumption ( O2), and gastric mucosal pH (pHi) in 12 patients with severe sepsis.
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the effects of low dose dopamine on Splanchnic Blood Flow and oxygen uptake in patients with septic shock
Intensive Care Medicine, 1997Co-Authors: Andreas Meierhellmann, Donald L. Bredle, Claudia Spies, L Hannemann, Michelle C Specht, Konrad ReinhartAbstract:OBJECTIVE To assess the effects of low-dose dopamine on Splanchnic Blood Flow and Splanchnic oxygen uptake in patients with septic shock. DESIGN Prospective, controlled trial. SETTING University hospital intensive care unit. PATIENTS 11 patients with septic shock, diagnosed according the criteria of the 1992 American College of Chest Physicians/Society of Critical Care Medicine consensus conference, who required treatment with norepinephrine. MEASUREMENTS AND MAIN RESULTS Systemic and Splanchnic hemodynamics and oxygen transport were measured before and during addition of low-dose dopamine (3 micrograms/kg per min). Low-dose dopamine and a marked effect on total body hemodynamics and oxygen transport. The fractional Splanchnic Flow at baseline ranged from 0.15 to 0.57. In 7 patients with a fractional Splanchnic Flow less than 0.30, low-dose dopamine increased Splanchnic Flow and Splanchnic oxygen delivery and oxygen consumption. In 4 patients with a fractional Splanchnic Flow above 0.30, low-dose dopamine did not appear to change Splanchnic Blood Flow. CONCLUSION Low-dose dopamine has a potential beneficial effect on Splanchnic Blood Flow and oxygen consumption in patients with septic shock, provided the fractional Splanchnic Flow is not already high before treatment.
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Splanchnic Blood Flow is greater in septic shock treated with norepinephrine than in severe sepsis
Intensive Care Medicine, 1996Co-Authors: Andreas Meierhellmann, Donald L. Bredle, M Specht, L Hannemann, H Hassel, Konrad ReinhartAbstract:Objective To assess global and Splanchnic Blood Flow and oxygen transport in patients with sepsis with and without norepinephrine treatment.
Esko Ruokonen - One of the best experts on this subject based on the ideXlab platform.
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effect of dopamine induced changes in Splanchnic Blood Flow on megx production from lidocaine in septic and cardiac surgery patients
Shock, 2002Co-Authors: Stephan M Jakob, Esko Ruokonen, Per H Rosenberg, Jukka TakalaAbstract:The production of monoethylglycine xylidide (MEGX) from lidocaine is thought to be dependent on hepatic Blood Flow. We assessed the relationship between hepatoSplanchnic Blood Flow, lidocaine uptake, and the production of MEGX from lidocaine in seven patients after cardiac surgery and in nine septic patients. Systemic (pulmonary artery catheter) and Splanchnic (hepatic vein catheter and dye dilution) hemodynamics and arterial and hepatic venous lidocaine and MEGX concentrations were measured after a lidocaine bolus injection (1 mg/kg) before and 90 min after increasing cardiac output by at least 25% with dopamine. Dopamine infusion [in cardiac surgery patients 4.2 (1.4-8.5) microg x kg(-1) x min(-1) (median, range) and in septic patients 4.0 (2.1-9.0) microg x kg(-1) x min(-1)] increased Splanchnic Blood Flow in cardiac surgery patients from 0.65 (0.12) L x min(-1) x m(-2) to 0.84 (0.14) L x min(-1) x m(-2) mean (standard deviation) P = 0.018) and in septic patients from 0.91 (0.32) L x min(-1) x m(-2) to 1.12 (0.40) L x min(-1) x m(-2) (P = 0.038). Splanchnic MEGX production for the 30 min after lidocaine injection was higher in cardiac surgery patients than in septic patients both at baseline [4130 (1100) microg x m(-2) vs. 930 (420) microg x m(-2) (P < 0.005)] and afterdopamine infusion [4480 (1000) microg x m(-2) vs. 1090 (620) microg x m(-2) (P = 0.005)]. We found no correlation between changes in MEGX production and changes in Splanchnic Blood Flow. Patients with sepsis have severe impairment of cytochrome P450-dependent liver function, which is not influenced by acute changes in hepatoSplanchnic Blood Flow. MEGX production cannot be used as an estimate of changes in Splanchnic Blood Flow.
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the effect of dobutamine infusion on Splanchnic Blood Flow and oxygen transport in patients with acute pancreatitis
Intensive Care Medicine, 1997Co-Authors: Esko Ruokonen, Ari Uusaro, E Alhava, Jukka TakalaAbstract:Objectives: To measure the Blood Flow distribution and oxygen transport in pancreatitis and to evaluate the regional effects of increased systemic Blood Flow. Design: Nonrandomized controlled trial. Setting: A general intensive care unit in a tertiary care center. Patients: 10 patients with pancreatitis requiring mechanical ventilation were studied after fluid resuscitation, and for the response to dobutamine, the patients served as their own controls. For the baseline, 11 patients scheduled for elective abdominal surgery served as a control group. Interventions: Systemic and regional hemodynamics were measured after fluid resuscitation to predefined hemodynamic endpoints. In patients with pancreatitis, the measurement was repeated after cardiac output had been increased by at least 25 % by dobutamine. Measurements and results: HepatoSplanchnic Blood Flow was estimated using regional catheterization and the dye dilution method. In patients with pancreatitis, the cardiac index did not differ from that of the control group (3.9 ± 0.8 vs 4.1 ± 0.7 l · min–1· m–2;NS). Accordingly, there was no difference in the Splanchnic Blood Flow (1.1 ± 0.4 vs 1.2 ± 0.5 l · 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 vs23 ± 0.05, p < 0.01 and 0.46 ± 0.18 vs 0.28 ± 0.08, p < 0.05, respectively). Dobutamine had inconsistent effects on Splanchnic Blood Flow: in individual patients, Splanchnic Blood Flow even decreased substantially. 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 Flow with dobutamine does not improve perfusion in the Splanchnic bed.
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sodium nitroprusside after cardiac surgery systemic and Splanchnic Blood Flow and oxygen transport
Acta Anaesthesiologica Scandinavica, 1996Co-Authors: Ilkka Parviainen, Esko Ruokonen, Jukka TakalaAbstract:BACKGROUND Vasoactive drugs may interfere with Splanchnic Blood Flow and tissue oxygenation. Sodium nitroprusside (SNP) is widely used in the treatment of postoperative hypertension after cardiac surgery, but the effects of SNP and other vasodilators on Splanchnic Blood Flow have not been well documented. METHODS The effects of SNP on systemic Blood Flow, oxygen transport and gastric intramucosal pH (pHi) were studied in 12 patients with arterial hypertension after coronary artery bypass grafting. In 9 of these patients, the effect on regional (Splanchnic and leg) Blood Flow and oxygen transport was also measured. Hemodynamic and regional Blood Flow responses were measured before and during SNP infusion (mean 2.8 +/- 1.7 micrograms/kg/min, range 0.6-6.3 micrograms/kg/min), when the goal of the vasodilator treatment, mean arterial pressure 70-80 mmHg, had been reached. RESULTS SNP increased Splanchnic (0.65 +/- 0.22 vs. 0.87 +/- 0.37 L.min-1.m-2, P < 0.01) and femoral Blood Flow (0.15 +/- 0.04 vs. 0.21 +/- 0.06 L.min-1.m-2, P < 0.05) in parallel with cardiac index (2.6 +/- 0.6 vs. 3.3 +/- 0.7 L.min-1.m-2, P < 0.01). Fractional regional Blood Flows did not change. Mean gastric intramucosal pH decreased slightly (7.40 +/- 0.07 vs. 7.37 +/- 0.06, P < 0.05). Both systemic (420 +/- 85 vs. 495 +/- 90 mL.min-1.m-2, P < 0.05) and femoral oxygen delivery (25 +/- 5 vs. 32 +/- 10 mL.min-1.m-2, P < 0.05) increased, but neither systemic nor regional oxygen consumption changed. CONCLUSIONS These results suggest that vasoregulation is well preserved during treatment of early postoperative hypertension with SNP, and that SNP has no adverse effects on Splanchnic tissue oxygenation.
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Gastric mucosal pH does not reflect changes in Splanchnic Blood Flow after cardiac surgery
British journal of anaesthesia, 1995Co-Authors: Ari Uusaro, Esko Ruokonen, Jukka TakalaAbstract:Despite the widespread use of gastric tonometry to assess Splanchnic oxygen transport, no human data are available on the relationship between Splanchnic Blood Flow, Splanchnic oxygen delivery and gastric mucosal pH. We have studied the effect of Splanchnic Blood Flow and oxygen delivery on gastric mucosal pH after cardiac surgery. During the first postoperative hours of intensive care, dopexamine was infused to increase cardiac output in eight patients, while six patients served as controls. Gastric mucosal pH (gastric tonometry), Splanchnic Blood Flow and Splanchnic oxygen delivery and consumption (dye dilution) were measured. Dopexamine administration significantly increased Splanchnic Blood Flow (0.72 vs 1.02 litre min−1 m−2 (P
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Dobutamine-induced dissociation between changes in Splanchnic Blood Flow and gastric intramucosal pH after cardiac surgery
British journal of anaesthesia, 1995Co-Authors: Ilkka Parviainen, Esko Ruokonen, Jukka TakalaAbstract: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 (P
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effect of dopexamine on hepatic metabolic activity in patients with septic shock
Shock, 2001Co-Authors: Peter Kiefer, I Tugtekin, Heide Wiedeck, Josef Vogt, Uli Wachter, Hendrik Bracht, G Geldner, Michael K Georgieff, Peter RadermacherAbstract:Hepato-Splanchnic metabolic activity is seen to be related to regional Blood Flow and oxygen/substrate availability in patients with sepsis. Catecholamines, which may modulate metabolic activity perse, are common to stabilize hemodynamics. We studied the effect of a dopexamine-induced increase in Splanchnic Blood Flow (Qspl) on regional metabolic rate in 10 patients with septic shock requiring norepinephrine to maintain mean arterial pressure (>60 mmHg). Splanchnic Blood Flow was determined using the indocyanine-green method with hepatic venous sampling. We determined the hepato-Splanchnic lactate, pyruvate, alanine, and glutamine turnover and the lactate/pyruvate and ketone body ratio as well as the endogenous glucose production (EGP) using the stable isotope approach. Qspl increased from 0.86 (0.79-1.15) to 0.96 (0.92-1.33) L/min/m2, not influencing any parameter of metabolic activity. We speculate that this finding is due to altered beta-adrenoreceptor-mediated thermogenic effects due to the interplay of different beta-sympathomimetics at the receptor site.
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impact of exogenous beta adrenergic receptor stimulation on hepatoSplanchnic oxygen kinetics and metabolic activity in septic shock
Critical Care Medicine, 1999Co-Authors: Helmut Reinelt, Peter Kiefer, Josef Vogt, Peter Radermacher, Gunther Fischer, Ulrich Wachter, Michael K GeorgieffAbstract:ObjectiveTo investigate the impact of exogenous beta-adrenergic receptor stimulation on Splanchnic Blood Flow, oxygen kinetics, glucose-precursor flux, and liver metabolism in septic shock.DesignProspective trial.SettingUniversity hospital intensive care unit.PatientsSix patients with hyperdynamic (
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effects of a dobutamine induced increase in Splanchnic Blood Flow on hepatic metabolic activity in patients with septic shock
Anesthesiology, 1997Co-Authors: Helmut Reinelt, Heide Wiedeck, Michael K Georgieff, Peter Radermacher, Gunther Fischer, W Geisser, Ulrich Wachter, Josef VogtAbstract:Background: Septic shock leads to increased Splanchnic Blood Flow (Qspl) and oxygen consumption (VO 2 spl). The increased Qspl, however, may not match the Splanchnic oxygen demand, resulting in hepatic dysfunction. This concept of ongoing tissue hypoxia that can be relieved by increasing Splanchnic oxygen delivery (DO 2 spl), however, was challenged because most of the elevated VO 2 spl was attributed to increased hepatic glucose production (HGP) resulting from increased substrate delivery. Therefore the authors tested the hypothesis that a dobutamine-induced increase in Qspl and DO 2 spl leads to increased VO 2 spl associated with accelerated HGP in patients with septic shock. Methods: Twelve patients with hyperdynamic septic shock in whom Blood pressure had been stabilized (mean arterial pressure ≥70 mmHg) with volume resuscitation and norepinephrine received dobutamine to obtain a 20% increase in cardiac index (CI). Qspl, DO 2 spl, and VO 2 spl were assessed using the steady-state indocyanine green clearance technique with correction for hepatic dye extraction, and HGP was determined from the plasma appearance rate of stable, non-radioactive-labeled glucose using a primed-constant intrusion approach. Results: Although the increase in Cl resulted in a similar increase in Qspl (from 0.91 ± 0.21 to 1.21 + 0.34 1. min -1 .m 2 ; P < 0.001) producing a parallel increase of DO 2 spl (from 141 ± 33 to 182 ± 44 ml. min -1 . m 2 ; P < 0.001), there was no effect on VO 2 spl (73 ± 16 and 82 ± 21 ml. min -1 . m 2 , respectively). Hepatic glucose production decreased from 5.1 ± 1.6 to 3.6 ± 0.9 mg.kg -1 . min -1 (P < 0.001). Conclusions: In the patients with septic shock in whom Blood pressure had been stabilized with volume resuscitation and norepinephrine, no delivery-dependency of VO 2 spl could be detected. Oxygen consumption was not related to the accelerated HGP either, and thus the concept that HGP dominates VO 2 spl must be questioned in well-resuscitated patients with septic shock.
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dobutamine and dopexamine and the Splanchnic metabolic response in septic shock
Clinical Intensive Care, 1997Co-Authors: Helmut Reinelt, Heide Wiedeck, Peter Radermacher, Gunther Fischer, W Geisser, E Trunk, M Mezody, M Georgieff, Josef VogtAbstract:We report the case of a 41-year-old male with hyper-dynamic septic shock requiring noradrenaline in addition to volume resuscitation in order to maintain a mean arterial Blood pressure >70 mmHg. However, despite satisfactory global haemodynamics and gas exchange, he exhibited persistent renal failure and hepatic dysfunction (MGEX 1,000 U/l) as well as gastric intramucosal acidosis (pHi 7.17). In an attempt to improve Splanchnic O2 delivery we tested the effects of infusions of dobutamine (10 μg/kg/ min) and dopexamine (2 μg/kg/min). In addition to measuring Splanchnic Blood Flow using the steady-state infusion indocyanine-green clearance technique, we analysed the hepatic metabolic response. The latter was estimated by determination of the hepatic glucose production rate (HGP), and Splanchnic alanine uptake and lactate clearance. Both drugs comparably increased Splanchnic Blood Flow and O2 availability. While both Splanchnic O2 and alanin...
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effects of increased regional Blood Flow on Splanchnic metabolism
Intensive Care Medicine, 1996Co-Authors: Helmut Reinelt, Heide Wiedeck, Josef Vogt, M Mezody, M Georgieff, G Fischer, Peter RadermacherAbstract:Unlike in healthy volunteers in patients with septic shock the hepatic metabolic response to adrenergic stimulation may not mirror the catecholamine-induced increase in Splanchnic Blood Flow. Given the high O2 cost of hepatic gluconcogenesis, infusing dobutamine may potentially reduce hepatic energy requirements in these patients.
