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Objectives: Previous studies on therapeutic interventions in sepsis have assumed stability of the measure of splanchnic blood flow throughout the study. We assessed the variability of splanchnic blood flow during stable global hemodynamics in eight patients with sepsis requiring treatment with dobutamine and/or norepinephrine.Design and Setting: Prospective clinical study in an intensive care unit of a university hospital.Measurements and Results: Global and regional hemodynamics were measured at baseline, 2 h later, and 4 h later. Cardiac output was measured by transpulmonary thermodilution, intrathoracic blood volume as an indicator of cardiac preload, and total blood volume by the double indicator (thermo-dye) dilution technique. Total body oxygen consumption was assessed by indirect calorimetry using a metabolic cart. Splanchnic blood flow was measured by the continuous indocyanine green method, and gastric mucosal CO2 tension by gas tonometry. Neither absolute nor fractional splanchnic blood flow (as ratio of cardiac output) revealed significant global tendencies during the study period. However, variance component analysis showed that splanchnic blood flow determinations varied considerably within patients, for repeated measurements at 5-min intervals (standard error 31.1%) as well as for average values at 2-h intervals (25.6%).Conclusion: Stable global hemodynamics during a 4-h period in septic patients does not exclude marked changes in splanchnic blood measured by a hepatic venous catheter technique. [ABSTRACT FROM AUTHOR]

Objectives: We studied the correlation between invasive (aortic fiberoptic) and noninvasive (transcutaneous sensor) measurements of indocyanine green (ICG) plasma disappearance rate (PDR) in critically ill patients.Design and Setting: Prospective clinical study in a surgical intensive care unit of a university hospital.Patients: 16 critically ill patients with adult respiratory distress syndrome (n = 8), sepsis/septic shock (n = 6), subarachnoid hemorrhage (n = 1), or severe head injury (n = 1).Measurements and Results: We analyzed 16 pairs of simultaneous ICG PDR measurements. All patients were deeply sedated and mechanically ventilated. Each patient received a 4-F aortic catheter with an integrated fiberoptic and thermistor connected to a computer system for automatic calculation of invasive ICG PDR (PDRINV). An ICG sensor was also attached to the nose wing and connected to a DDG2001 analyzer for noninvasive measurement (PDRNINV). Linear regression analysis revealed PDRNINV = 0.98 PDRINV +0.11%/min (r = 0.94, p < 0.0001) with a mean bias of 0.2 +/- 2.0%/min.Conclusion: Noninvasive measurements of ICG PDR are very highly correlated with values derived from an invasive fiberoptic-based reference technique. [ABSTRACT FROM AUTHOR]