Effect of dopamine on gastrointestinal motility during critical illness.

OBJECTIVE

To document the action of dopamine on gastrointestinal motility in mechanically ventilated patients.

DESIGN

Crossover, randomized, placebo-controlled study.

SETTING

General intensive care unit (ICU) in a university hospital.

PATIENTS

Twelve mechanically ventilated patients in a stable hemodynamic condition, with no contraindication to enteral feeding.

INTERVENTIONS

Dopamine (4 microg/kg per minute) and placebo were infused over 8 h (4 h fasting, followed immediately by 4 h nasogastric feeding at 100 kcal per hour) on two consecutive days, in a random order. Pressure changes in the gastric antrum (four sites) and in the duodenum (two sites) were recorded by perfused catheter manometry. Each session started with the institution of dopamine or placebo infusion.

MEASUREMENTS AND RESULTS

The migrating motor complex and its three successive phases were identified (phase I, period of quiescence; phase II, period of irregular contractile activity; phase III or activity front, period of high-frequency, regular contractions). Contractions and activity fronts at each site were quantified during fasting and feeding. The mean duration of the fasting migrating motor complex was determined in the duodenum, as well as the contribution of each phase (phases I, II, III) to the length of the complete cycle. The propagation characteristics of each activity front were assessed visually. The number of contractions was lower in the antrum (p = 0.024) and phase III motor activity higher in the duodenum [incidence of activity fronts (p = 0.008); number of phase III contractions (p = 0.009)] during dopamine infusion than with placebo. These modifications observed under dopamine were related to decreased antral contractions during fasting (p = 0.050), increased incidence of activity fronts during feeding (p = 0.031), and increased number of phase III contractions during fasting (p = 0.037). In both groups (placebo and dopamine) activity fronts rarely started in the antrum, and abnormally propagated activity fronts were found in the duodenum in some patients.

CONCLUSIONS

Low-dose dopamine adversely affects gastroduodenal motility in mechanically ventilated critically ill patients.