Exogenous beta-adrenergic receptor stimulation determines splanchnic blood flow, oxygen delivery, and glucose precursor flux but not splanchnic oxygen utilization in septic shock. Gluconeogenesis is not directly affiliated to hepatosplanchnic oxygen kinetics. The different response of glucose and MEGX production rates, metabolic pathways of the periportal and perivenous region, may document intrahepatic heterogeneity associated with hepatocellular metabolic compartmentation.

Using the POVOC score, PV in pediatric patients can be predicted with sufficient accuracy comparable to the results in adult patients, even if one of the risk factors is not applicable.

PEEP by itself does not have a consistent effect on splanchnic blood flow and metabolism when cardiac index is stable and patients are ventilated within the linear part of the pv curve.

In patients with septic shock an iloprost-induced increase in cardiac index increased splanchnic blood flow and shifted oxygen utilization from the energy requiring de novo glucose production rate to other oxygen-demanding metabolic pathways.

In 12 patients with hyperdynamic septic shock we studied the effect of dopexamine, a combined dopamine and beta-adrenergic agonist, on hepatosplanchnic hemodynamics and O(2) exchange. All patients required noradrenaline to maintain mean arterial pressure > 60 mm Hg (noradrenaline >/= 0.04 microg x kg(-1) x min(-1)) with a cardiac index >/= 3.0 L/min/m(2). Splanchnic blood flow (Qspl) was measured using primed continuous infusion of indocyanine green dye with hepatic venous sampling. In addition tonometric gastric mucosal-arterial and gastric mucosal-hepatic venous P CO(2) gradients were assessed as indicators of regional energy balance. After 90 min of stable hemodynamics a first measurement was obtained. Then dopexamine infusion was titrated (1-4 microg x kg(-1) x min(-1)) to increase cardiac output by approximately 25% (20-30%). After 90 min all measurements were repeated, and dopexamine was withdrawn followed by a third measurement. Median Qspl (0.86/1.23-0. 66 versus 0.96/1.42-0.85 L/min/m (2) [median value/25th-75th percentiles], p < 0.05) increased whereas the fractional contribution of Qspl to total blood flow decreased (21/28-13 versus 19/28-12%, p < 0.05). Although both global and regional oxygen delivery (DO(2)) consistently increased, neither global or regional V O(2) nor PCO(2) gradients were significantly affected. In patients with septic shock and ongoing noradrenaline treatment dopexamine seems to have no preferential effects on hepatosplanchnic hemodynamics, O(2) exchange, or energy balance.