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Splanchnic blood flow is greater in septic shock treated with norepinephrine than in severe sepsis
Authors:A. Meier-Hellmann  M. Specht  L. Hannemann  H. Hassel  D. L. Bredle  K. Reinhart
Affiliation:(1) Department of Anesthesia and Critical Care Medicine, Friedrich Schiller University Jena, Bachstrasse 18, D-07743 Jena, Germany;(2) Department of Anesthesia and Critical Care Medicine, Benjamin Franklin Clinic, Free University of Berlin, Germany;(3) Department of Internal Medicine, Northeastern Ohio University College of Medicine, Rootstown, Ohio, USA
Abstract:Objective To assess global and splanchnic blood flow and oxygen transport in patients with sepsis with and without norepinephrine treatment.Design Prospective, clinical study.Setting University hospital intensive care unit.Patients A convenience sample of 15 septic shock patients treated with norepinephrine and 13 patients with severe sepsis who did not receive norepinephrine.Measurements and main results There were no differences between the two groups in global haemodynamics and oxygen transport. Splanchnic blood flow and oxygen delivery (splanchnic DO2 303±43 ml/min per m2) and consumption (splanchnic VO2 100±13 ml/min per m2) were much higher in the septic shock group compared with the severe sepsis group (splanchnic DO2 175±19 ml/min per m2, splanchnic VO2 61±6 ml/min per m2). Gastric mucosal pH was subnormal in both groups (septic shock 7.29±0.02, severe sepsis 7.25±0.02) with no significant difference. No significant differences between groups were detected in lactate values.Conclusion These data confirm a redistribution of blood flow to the splanchnic region in sepsis that is even more pronounced in patients with septic shock requiring norepinephrine. However, subnormal gastric mucosal pH suggested inadequate oxygenation in part of the splanchnic region due to factors other than splanchnic hypoperfusion. Progress in this area will depend on techniques that address not only total splanchnic blood flow, but also inter-organ flow distribution, intra-organ distribution, and other microcirculatory or metabolic malfunctions.
Keywords:Septic shock  Sepsis  Splanchnic blood flow  Splanchnic oxygen delivery  Splanchnic oxygen consumption  Norepinephrine
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