The effect of dobutamine on hepatic blood flow during goal-directed therapy: preliminary results

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Background: The influence of dobutamine on the liver blood flow during major abdominal surgery is not fully understood. The primary goal is to study the effect of dobutamine on the blood flow in the portal vein (PVF), the hepatic artery blood flow (HAF) and the hepatic blood flow (HBF). Methods: Patients who were scheduled for pancreaticoduodenectomy were selected for inclusion and an informed consent was taken. Flow measurements are made with ultrasound transit time flow probes. Hemodynamic data was measured using the PulsioFlexTM. These hemodynamic data were measured at designated times: after resection (T1), after 10 minute infusion of 2 µg.kg-1.min-1 dobutamine (T3) and after 10 minutes of 5 µg.kg-1.min-1 dobutamine infusion (T4). In this study the first 15 included patients were analyzed. Primary endpointwas to determine the change in hepatic artery blood flow index (HAFi), portal vein flow index (PVFi) and hepatic blood flow index (HBFi). Secondary endpoints were to study the changes in the measured hemodynamic data. A total of 26 patients were selected, with inclusion of 15 patients for further analysis. Statistical analysis was made using ANOVA for repeated measurements. Results: A total of 15 patients were included for statistical analysis. A significant increase in HBFi at T4, compared to baseline, was seen due to a dose-dependant increase in PVFi. In the hepatic artery, a steady decline of HAFi was measured. For secondary outcomes, a rise in mean cardiac index (CI) and a decrease in mean systemic vascular resistance index (SVRI) was seen. Discussion and Conclusions: In this study, an increase in HBF was measured through an increase in PVF. Because the hepatic artery buffer system, the HAF decreased. This might suggest that dobutamine is capable of modulating the HBF during major abdominal surgery. For secondary outcomes, a rise in CI at low dose dobutamine infusion, but not increasing further at higher infusion rate, was seen.

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