Effects of norepinephrine, epinephrine, and norepinephrine-dobutamine on systemic and gastric mucosal oxygenation in septic shock.

AIM: To compare the effects of dopamine, norepinephrine, epinephrine, and the combination of norepinephrine and dobutamine on systemic and gastric mucosal oxygen metabolism in patients with septic shock.

METHODS: Sixteen patients with septic shock were enrolled in the present study. Each patient received dopamine firstly, then in a random succession epinephrine, norepinephrine, or norepinephrine-dobutamine, a mean systemic arterial pressure adjusted to >9.31 kPa. After 120 min of each treatment, hemodynamic, oxygen metabolic, and gastric mucosal parameters were obtained.

RESULTS: Epinephrine induced a significant increase in heart rate compared with other three groups (P <0.05), and a significant higher cardiac index compared with norepinephrine alone and norepinephrine-dobutamine (P <0.05). Oxygen extraction ratio values were lower with epinephrine infusion as compared with other three groups (P <0.05). Arterial lactate concentrations decreased significantly with norepinephrine-dobutamine as compared with dopamine and epinephrine infusions (P <0.05). As compared with epinephrine infusion, the gastric intramucosal pH values were higher with norepinephrine-dobutamine infusion (7.25+/-0.09 vs 7.14+/-0.07, P <0.05).

CONCLUSION: Dopamine, norepinephrine, epinephrine, or norepinephrine-dobutamine improved blood pressure. Epinephrine and dopamine had deleterious effect on oxygen metabolism, while norepinephrine plus low dose of dobutamine improved gastric mucosal perfusion and tissue oxygen utilization.