Einfluss von Dopexamin und Iloprost auf die Plasma-Disappearance-Rate von Indozyaningrün bei Patienten im septischen Schock

Objectives. To evaluate the effect of dopexamine and iloprost on the plasma disappearance rate (PDR) of indocyanine green (ICG) in patients in septic shock in a prospective clinical trial. Methods. In 40 consecutive patients in septic shock, a femoral arterial fiberoptic catheter (COLD system) and a gastrotonometric probe were placed. Patients received either dopexamine infusion (0.5 μg/kg body weight/min) or iloprost (1 ng/kg body weight/min) for 24 h i.v. PDR, intramucosal pH of stomach wall (pH_j), cardiac index (HI) and intrathoracic blood volume (ITBV) were determined before, 1,6, and 24 h after dopexamine or iloprost infusion and 1 h after end of infusion. Results. PDR was significantly increased 24 h after starting dopexamine infusion from 12.2±1.8%/min to 17.8±2.2%/min (+45.9%) and 1 h after the end of infusion PDR decreased to baseline values. PDR increased to 16.4±2.1%/min, 1 h after starting iloprost infusion and increased to a maximum value of 18.6±2.2%/min (+33.8%, p<0.05) 24 h after start of infusion compared to the baseline (13.9±1.7%/min). After the end of infusion PDR decreased to baseline values. Baseline values of pH_j were in normal ranges in all groups and there was no change during the observation period. Cardiac index and ITBV were stable during the study. Dosage of norepinephrine could be reduced by dopexamine infusion. Conclusions. Dopexamine and iloprost have a positive effect on the plasma disappearance rate of ICG and therefore have a protective effect on splanchnic perfusion and liver function, respectively.