Document Detail


Effect of glucose-insulin-potassium in severe acute heart failure after brain death.
MedLine Citation:
PMID:  18766095     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: As a result of donor heart shortage, resorting to marginal heart donors is being promoted. Dobutamine is usually used to support these potential donors and has been proposed to identify the reversible part of the brain death-induced myocardial dysfunction before potential organ donation. But dobutamine impairs the oxygen supply-demand balance and may increase myocardial ischemia. The aim of this study was to compare the effects of dobutamine and glucose-insulin-potassium on the left ventricular systolic dysfunction in brain dead patients. METHODS AND RESULTS: One hundred thirty-five consecutive brain dead patients were prospectively screened. Twelve of them with severe acute heart failure defined by an echocardiographic ejection fraction area <30% received 10 microg/kg/min dobutamine infusion over 30 min and, after return to baseline cardiac function, glucose-insulin-potassium infusion over 120 min. With dobutamine, ejection fraction area significantly increased (39 +/- 14 vs. 21 +/- 6%, p < 0.0001) whereas mean diastolic arterial pressure decreased (71 +/- 9 vs. 89 +/- 18 mm Hg, p < 0.05) and heart rate increased (150 +/- 16 vs. 118 +/- 24 beats/min, p < 0.01). After glucose-insulin-potassium infusion, ejection fraction area significantly increased (37 +/- 8 vs. 21 +/- 6%, p < 0.0001), without significant changes in mean arterial blood pressure (79 +/- 16 vs. 89 +/- 18 mm Hg, nonsignificant) and heart rate (116 +/- 18 vs. 118 +/- 24 beats/min, nonsignificant). CONCLUSION: Glucose-insulin-potassium was as efficient as dobutamine in improving ventricular systolic function in brain-dead patients, without the side effects of dobutamine.
Authors:
Armelle Nicolas-Robin; Julien Amour; Cristina Ibanez-Esteve; Pierre Coriat; Bruno Riou; Olivier Langeron
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  36     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-25     Completed Date:  2008-10-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2740-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Centre Hospitalo-Universitaire Pitie-Salpetriere, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. armelle.nicolas-robin@psl.aphp.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Brain Death*
Confidence Intervals
Dobutamine / administration & dosage*
Drug Therapy, Combination
Echocardiography, Doppler
Echocardiography, Transesophageal
Female
Follow-Up Studies
Glucose / administration & dosage
Heart Failure / drug therapy*,  prevention & control,  ultrasonography
Heart Rate / drug effects
Heart Transplantation
Humans
Infusions, Intravenous
Insulin / administration & dosage
Male
Middle Aged
Organ Preservation / methods
Potassium / administration & dosage
Probability
Prospective Studies
Risk Factors
Severity of Illness Index
Stroke Volume / drug effects
Tissue Donors
Treatment Outcome
Ventricular Remodeling / drug effects
Chemical
Reg. No./Substance:
0/glucose-insulin-potassium cardioplegic solution; 11061-68-0/Insulin; 34368-04-2/Dobutamine; 50-99-7/Glucose; 7440-09-7/Potassium
Comments/Corrections
Comment In:
Crit Care Med. 2008 Oct;36(10):2933-4   [PMID:  18812796 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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