Hemodynamic and Metabolic Efficacy of Dopamine Versus Norepinephrine in a Brain-Dead Swine Model

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We tested the hypothesis that hepatosplanchnic and systemic hemodynamics are improved with equi-effective doses of dopamine (DA) versus norepinephrine (NE) in a brain-dead swine model. Pigs (n = 18) were anesthetized and ventilated. Brain death was induced by epidural balloon inflation, hypoventilation, and hypoxia. After 30 minutes, mechanical ventilation was restored without anesthesia. During 60 and until 480 minutes, half received DA (10 μg/kg/minute) and half received NE (0.1 μg/kg/minute) titrated to a mean arterial pressure (MAP) > 60 mm Hg with supplemental fluid to maintain a central venous pressure > 8 mm Hg. Hemodynamics, hepatic laser Doppler blood flow, and hepatic and gastric tissue oxygenation with near-infrared spectroscopy were continuously monitored. Serial blood samples were analyzed for blood gases and electrolytes, coagulation changes, and serum chemistries. Balloon inflation caused brain death and autonomic storm, and 8 of 18 were nonsurvivors. After 30 minutes, the MAP, mixed venous O2 saturation, and partial pressure of arterial oxygen values decreased to 37 ± 2 mm Hg, 38 ± 4, and 49 ± 8 mm Hg, respectively. Serum lactate increased to 5.4 ± 0.7 mM. Among survivors (n = 10), MAP stabilized with either pressor. Urine output was maintained (>1 mL/kg/hour), but creatinine increased >30% with respect to the baseline. Tachyphylaxis developed with NE but not with DA (P< 0.05). Cardiac index was higher with DA versus NE (P< 0.05). There were no differences in stroke volume, metabolic indices, or liver blood flow. Liver tissue O2 was higher with DA versus NE at 8 hours (P< 0.05). Coagulation tests and liver enzymes were similar with NE versus DA (P> 0.05). In conclusion, after brain death, cardiac index and hepatic oxygenation were significantly improved with equi-effective doses of DA versus NE.

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