Document Detail


Heterogeneity and prediction of hemodynamic responses to dobutamine in patients with septic shock.
MedLine Citation:
PMID:  16849997     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To establish the heterogeneity of hemodynamic responses to dobutamine in patients with septic shock and to identify the predictive factors of these hemodynamic responses. DESIGN: Prospective study. SETTING AND PATIENTS: A total of 12 patients with septic shock in a tertiary medical intensive care unit. INTERVENTIONS: A 20-min dobutamine infusion at 5 microg.kg(-1).min(-1) with subsequent increments to 8, 12.6, and 20 microg.kg(-1).min(-1), on two consecutive days. Responses were dichotomized into changes in heart rate (HR) or stroke volume index (SVI) of >10% and < or =10% at the maximal dobutamine infusion. MEASUREMENTS AND MAIN RESULTS: No differences were found in survival, Acute Physiology and Chronic Health Evaluation II score, maximal dobutamine doses, or pharmacokinetics of dobutamine between HR and SVI groups. In DeltaHR > 10% vs. DeltaHR < or = 10%, baseline HR was lower, and baseline mixed venous oxygen tension and saturation were higher. During dobutamine infusion, mean arterial pressure decreased in DeltaHR > 10%. Cardiac index and the systemic oxygen delivery index increased and the systemic vascular resistance index decreased at unchanged SVI. Pressure work index increased and the ratio of the diastolic to systolic aortic pressure time indices decreased but not to <0.6. In DeltaHR < or = 10%, systemic vascular resistance index and the ratio of the diastolic to systolic aortic pressure time indices decreased (but remained >0.6) without changes in SVI or cardiac index. Baseline hemodynamic and metabolic variables did not differ between SVI groups. In DeltaSVI > 10%, cardiac index increased with dobutamine, but Pao2 and the systemic oxygen delivery index decreased. In DeltaSVI < or = 10%, HR and the systemic oxygen delivery index increased; mean arterial pressure, left ventricular stroke work index, systemic vascular resistance index, and the ratio of the diastolic to systolic aortic pressure time indices decreased. CONCLUSIONS: Patients with a positive chronotropic response to dobutamine had lower baseline HR values, and a chronotropic rather than inotropic response predicted an increase in cardiac index and systemic oxygen delivery index. Incremental dosages of dobutamine did not compromise indirectly measured myocardial oxygen balance.
Authors:
Wilbert T Jellema; A B Johan Groeneveld; Karel H Wesseling; Lambertus G Thijs; Nico Westerhof; Johannes J van Lieshout
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  34     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-08-21     Completed Date:  2006-09-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2392-8     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Research Institute Amsterdam, the Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aorta / physiology
Blood Pressure / drug effects,  physiology
Cardiac Output / drug effects*,  physiology
Cardiotonic Agents / administration & dosage*,  pharmacokinetics
Diastole / drug effects,  physiology
Dobutamine / administration & dosage*,  pharmacokinetics
Dose-Response Relationship, Drug
Female
Heart Rate / drug effects*,  physiology
Humans
Infusions, Intravenous
Intensive Care Units
Male
Middle Aged
Oxygen / blood
Prospective Studies
Shock, Septic / drug therapy*,  physiopathology
Systole / drug effects,  physiology
Vascular Resistance / drug effects,  physiology
Ventricular Function, Left / drug effects,  physiology
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 34368-04-2/Dobutamine; 7782-44-7/Oxygen

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


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