Improving organ perfusion

It is important to consider maintenance or enhancement of specific organ perfusion.

Blood flow and oxygen delivery to the brain are autoregulated. Below a certain systemic blood pressure (usually about 80 mmHg), brain blood flow is directly proportional to systemic blood pressure.

The heart is only perfused during diastole. Thus it is essential not to give agents that increase the heart rate so that it limits myocardial oxygen delivery. There are also specific coronary vasodilators, such as nitrates, which can be used to improve coronary artery blood flow.

If oliguria develops despite adequate filling and perfusion pressure, use of a loop diuretic such as furosemide (frusemide) and/or dopamine should be considered. The combined use of furosemide and dopamine in patients who are normotensive and have adequate intravascular fluid replacement has been shown to reduce acute renal failure and attenuate the severity of established acute renal failure ( y..n.d.D.e..r..,I9.ยง.3).

Splanchnic perfusion may be improved by using specific dopamine receptor agonists such as dopamine or dopexamine. This may reduce toxin load and bacterial translocation, which have been implicated in the development of multiple organ failure.

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