Cerebral effects of commonly used vasopressor-inotropes: a study in newborn piglets.

<h4>Background</h4>Despite widespread use in sick infants, it is still debated whether vasopressor-inotropes have direct cerebral effects that might affect neurological outcome. We aimed to test direct cerebrovascular effects of three commonly used vasopressor-inotropes (adrenaline, dopa...

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Autores principales:	Gitte H Hahn, Simon Hyttel-Sorensen, Sandra M Petersen, Ole Pryds, Gorm Greisen
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/186ab10f67de48329e5138c904a0fbf3
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spelling	oai:doaj.org-article:186ab10f67de48329e5138c904a0fbf32021-11-18T07:45:12ZCerebral effects of commonly used vasopressor-inotropes: a study in newborn piglets.1932-620310.1371/journal.pone.0063069https://doaj.org/article/186ab10f67de48329e5138c904a0fbf32013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23700412/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Despite widespread use in sick infants, it is still debated whether vasopressor-inotropes have direct cerebral effects that might affect neurological outcome. We aimed to test direct cerebrovascular effects of three commonly used vasopressor-inotropes (adrenaline, dopamine and noradrenaline) by comparing the responses to those of nonpharmacologically induced increases in blood pressure. We also searched for reasons for a mismatch between the response in perfusion and oxygenation.<h4>Methods</h4>Twenty-four piglets had long and short infusions of the three vasopressor-inotropes titrated to raise mean arterial blood pressure (MAP) 10 mmHg in random order. Nonpharmacological increases in MAP were induced by inflation of a balloon in the descending aorta. We measured cerebral oxygenation (near-infrared spectroscopy), perfusion (laser-Doppler), oxygen consumption (co-oximetry of arterial and superior sagittal sinus blood), and microvascular heterogeneity (side stream dark field video microscopy).<h4>Results</h4>Vasopressor-inotropes increased cerebral oxygenation significantly less (p≤0.01) compared to non-pharmacological MAP increases, whereas perfusion was similar. Furthermore, cerebral total hemoglobin concentration increased significantly less during vasopressor-inotrope infusions (p = 0.001). These physiologic responses were identical between the three vasopressor-inotropes (p>0.05). Furthermore, they induced a mild, although insignificant increase in cerebral metabolism and microvascular heterogeneity (p>0.05). Removal of the scalp tissue did not influence the mismatch (p>0.05).<h4>Conclusion</h4>We demonstrated a moderate vasopressor-inotrope induced mismatch between cerebral perfusion and oxygenation. Scalp removal did not affect this mismatch, why vasopressor-inotropes appear to have direct cerebral actions. The statistically nonsignificant increases in cerebral metabolism and/or microvascular heterogeneity may explain the mismatch. Alternatively, it may simply reflect a vasopressor-inotrope-induced decrease in the arterial-to-venous volume ratio as detected by near-infrared spectroscopy.Gitte H HahnSimon Hyttel-SorensenSandra M PetersenOle PrydsGorm GreisenPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 5, p e63069 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Gitte H Hahn Simon Hyttel-Sorensen Sandra M Petersen Ole Pryds Gorm Greisen Cerebral effects of commonly used vasopressor-inotropes: a study in newborn piglets.
description	<h4>Background</h4>Despite widespread use in sick infants, it is still debated whether vasopressor-inotropes have direct cerebral effects that might affect neurological outcome. We aimed to test direct cerebrovascular effects of three commonly used vasopressor-inotropes (adrenaline, dopamine and noradrenaline) by comparing the responses to those of nonpharmacologically induced increases in blood pressure. We also searched for reasons for a mismatch between the response in perfusion and oxygenation.<h4>Methods</h4>Twenty-four piglets had long and short infusions of the three vasopressor-inotropes titrated to raise mean arterial blood pressure (MAP) 10 mmHg in random order. Nonpharmacological increases in MAP were induced by inflation of a balloon in the descending aorta. We measured cerebral oxygenation (near-infrared spectroscopy), perfusion (laser-Doppler), oxygen consumption (co-oximetry of arterial and superior sagittal sinus blood), and microvascular heterogeneity (side stream dark field video microscopy).<h4>Results</h4>Vasopressor-inotropes increased cerebral oxygenation significantly less (p≤0.01) compared to non-pharmacological MAP increases, whereas perfusion was similar. Furthermore, cerebral total hemoglobin concentration increased significantly less during vasopressor-inotrope infusions (p = 0.001). These physiologic responses were identical between the three vasopressor-inotropes (p>0.05). Furthermore, they induced a mild, although insignificant increase in cerebral metabolism and microvascular heterogeneity (p>0.05). Removal of the scalp tissue did not influence the mismatch (p>0.05).<h4>Conclusion</h4>We demonstrated a moderate vasopressor-inotrope induced mismatch between cerebral perfusion and oxygenation. Scalp removal did not affect this mismatch, why vasopressor-inotropes appear to have direct cerebral actions. The statistically nonsignificant increases in cerebral metabolism and/or microvascular heterogeneity may explain the mismatch. Alternatively, it may simply reflect a vasopressor-inotrope-induced decrease in the arterial-to-venous volume ratio as detected by near-infrared spectroscopy.
format	article
author	Gitte H Hahn Simon Hyttel-Sorensen Sandra M Petersen Ole Pryds Gorm Greisen
author_facet	Gitte H Hahn Simon Hyttel-Sorensen Sandra M Petersen Ole Pryds Gorm Greisen
author_sort	Gitte H Hahn
title	Cerebral effects of commonly used vasopressor-inotropes: a study in newborn piglets.
title_short	Cerebral effects of commonly used vasopressor-inotropes: a study in newborn piglets.
title_full	Cerebral effects of commonly used vasopressor-inotropes: a study in newborn piglets.
title_fullStr	Cerebral effects of commonly used vasopressor-inotropes: a study in newborn piglets.
title_full_unstemmed	Cerebral effects of commonly used vasopressor-inotropes: a study in newborn piglets.
title_sort	cerebral effects of commonly used vasopressor-inotropes: a study in newborn piglets.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/186ab10f67de48329e5138c904a0fbf3
work_keys_str_mv	AT gittehhahn cerebraleffectsofcommonlyusedvasopressorinotropesastudyinnewbornpiglets AT simonhyttelsorensen cerebraleffectsofcommonlyusedvasopressorinotropesastudyinnewbornpiglets AT sandrampetersen cerebraleffectsofcommonlyusedvasopressorinotropesastudyinnewbornpiglets AT olepryds cerebraleffectsofcommonlyusedvasopressorinotropesastudyinnewbornpiglets AT gormgreisen cerebraleffectsofcommonlyusedvasopressorinotropesastudyinnewbornpiglets
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Cerebral effects of commonly used vasopressor-inotropes: a study in newborn piglets.

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