Zusammenfassung
Acute strategies for the treatment of critically ill patients include the concept of a pharmacologically induced increase of splanchnic perfusion. This concept is based on the hypothesis that gut dysfunction plays an important role in the pathophysiology of systemic inflammatory response and organ dysfunction syndrome, since there is evidence that gut mucosal acidosis may promote bacterial ...
Zusammenfassung
Acute strategies for the treatment of critically ill patients include the concept of a pharmacologically induced increase of splanchnic perfusion. This concept is based on the hypothesis that gut dysfunction plays an important role in the pathophysiology of systemic inflammatory response and organ dysfunction syndrome, since there is evidence that gut mucosal acidosis may promote bacterial translocation and poor clinical outcome. The pharmacologic support of gut perfusion in critically ill patients has been tested in numerous studies, using vasoactive agents like dopamine, dopexamine, dobutamine, epinephrine and norepinephrine or by application of non-adrenergic substances like prostacyclin, nitric oxide, N-acetylcysteine or pentoxifylline. In summary, dopamine and dopexamine seem to have a minimal effect on mucosal integrity and splanchnic blood flow, while dobutamine consistently showed beneficial effects on intramucosal pH and gut perfusion. Prostacyclin demonstrated promising results, while other non-adrenergic agents had no effect on splanchnic perfusion. The experimental and clinical examination of the pathophysiologic role of the gut and the support of the perfusion as a therapeutic strategy implicate some methodical problems (assessment and reliability of monitoring methods, experimental animal models and investigations in humans, definition of shock syndromes, heterogeneity of data base). Furthermore, in future studies it remains to be shown that correcting the abnormal physiologic state will confer clinical benefit.
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