Vasoactive drugs and the gut: is there anything new?

Abstract

Purpose of reviewSystemic changes in blood pressure and cardiac output induced by pressors and inotropes do not always correlate to improvements in regional perfusion. Since the gut is often referred to as the 'motor' of the systemic inflammatory response syndrome, the impact of vasoactive agents on splanchnic perfusion has theoretical importance. This review will highlight recent studies examining secondary effects of vasoactive agents on intestinal perfusion, metabolism, and barrier function. Recent findingsNorepinephrine has minimal impact on mesenteric blood flow although the combination of norepinephrine and dobutamine increases splanchnic blood flow in sepsis. Dopamine also increases mesenteric blood flow although this may be associated with negative hepatic energy balance at high does. Vasopressin and epinephrine both have negative effects on splanchnic blood flow. Newer inodilators levosimendan and olprinone preferentially improve mesenteric perfusion in animal models. Summary Secondary effects of norepinephrine and dopamine on splanchnic perfusion are minor compared with their systemic effects. While vasopressin usage is increasing in the intensive care unit, caution should be used because of its adverse effects on gut perfusion. Experimental agents for the treatment of heart failure have beneficial gut-specific effects although the clinical significance of this is currently limited by their availability.

High Level of Endotoxemia Following Out-of-Hospital Cardiac Arrest Is Associated With Severity and Duration of Postcardiac Arrest Shock*

“…Finally, a high epinephrine dose during CPR was also associated with endotoxemia, independently of the duration of CPR. This could be explained by the well-known detrimental effect of epinephrine on mesenteric blood flow (32). This finding could be one of the reasons of the paradoxical suspected negative effect of epinephrine bolus during CPR (33) but should be confirmed in larger study.…”

Pneumatosis Intestinalis in Patients With Severe Thermal Injury

“…There are multiple studies in the literature demonstrating that the use of vasoactive agents can alter both blood flow to and within the splanchnic vascular bed causing significant intestinal ischemia, infarction, and mortality. 19,26,30,31 In comparison, septic shock itself may lead to diminished blood flow to the splanchnic circulation, precipitate intestinal mucosal hypoperfusion, and possibly lead to intestinal infarction. 32 It was interesting that none of the surviving patients required vasopressor support before diagnosis of PI.…”

Inotrópicos en el postoperatorio de cirugía cardiovascular: estudio de corte transversal

“…No obstante, se usa ampliamente sin generar cambios en la morbilidad y mortalidad 23,24 . Otros estudios han demostrado que los fármacos catecolaminérgicos tienen efectos metabólicos reversibles y no comprometen la perfusión de órganos que sufren hipoperfusión en los estados de choque 25,26 . Por el contrario, la mayoría de los estudios avala el beneficio de la dobutamina en pacientes con síndrome de bajo gasto postoperatorio e hipertensión pulmonar, al tiempo que confirman sus efectos benéficos en la perfusión sistémica 11,24 .…”