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Gastrointestinal permeability following cardiopulmonary bypass: a randomised study comparing the effects of dopamine
D G Sinclair1, P E Houldsworth, B Keogh
1Unit of Critical Care, National Heart & Lung Institute, London, UK.
Objective:
To compare the effects of dopexamine and dopamine on the mucosal permeability of the gastrointestinal tract (GIT).
Design:
Prospective, randomised clinical trial.
Setting:
Intensive care unit of a postgraduate teaching hospital, London, England.
Patients:
Thirty patients undergoing elective surgery involving cardiopulmonary bypass, performed by a single surgeon.
Interventions:
Patients were randomly assigned to receive either dopexamine 2.0 micrograms/kg per min or dopamine 2.5 micrograms/kg per min for the duration of the study period.
Measurements And Main Results:
Hemodynamic parameters and gastric intramucosal pH (pHi) were measured at intervals throughout the study. GIT permeability was measured once, post-operatively, using the ratio of absorbed lactulose to L-rhamnose. The groups were similar with respect to demographics, pre- and post-operative risk factors. The lactulose/rhamnose ratio was (mean +/- SEM) 0.44 +/- 0.10 in the dopexamine group vs 0.65 +/- 0.08 in that receiving dopamine (p < 0.05). The dopexamine group had a significantly higher oxygen delivery preoperatively (479.5 +/- 32.0 ml/min per m2 vs 344.4 +/- 23.9 ml/min per m2 for dopamine, p < 0.01), but no other significant differences emerged between the groups.
Conclusions:
Compared to dopamine, dopexamine reduces GIT permeability following surgery involving cardiopulmonary bypass. The mechanism of this effect remains unclear.
