Effects of different combinations of vasoactive drugs and dobutamine on the inflammatory response and hepatic and intestinal perfusion during endotoxic shock in rabbits

Abstract

Gastrointestinal dysfunction is common in critically ill patients. Inotropes and vasopressors agents such as norepinephrine, dopamine, vasopressin, and dobutamine are used for cardiovascular support of patients with shock from various etiologies and sometimes at very high doses what can determine splanchnic ischemia and as a result exacerbation of the inflammatory response. Objective. The effects of vasopressors on splanchnic circulation are still unknown or controversial. The present study will evaluate the effects of different associations between inotropes and vasopressors on intestinal perfusion, hepatic perfusion, systemic inflammatory response, and heart rate during endotoxin shock. This knowledge can contribute to the design of clinical studies in patients with septic shock admitted to intensive care units in order to recommend more appropriate treatments and with less risk of adverse effects on the gastrointestinal tract. Methods. We will undertake this study in an animal model of endotoxic shock treated with different associations of inotropes and vasopressors. Global tissue perfusion will be evaluated by measuring serum lactate, central venous oxygen saturation, and blood gas analysis. Intestinal perfusion will be evaluated by measuring the pH and ileal intramucosal PCO2, lactate concentration in the ileal mucosa, and veno-arterial PCO2 gap. Hepatic injury will be assessed by measurements of serum transaminases. (AU)