Document Detail


The effects of dobutamine and dopamine on intrapulmonary shunt and gas exchange in healthy humans.
MedLine Citation:
PMID:  22700799     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The development of intrapulmonary shunts with increased cardiac output during exercise in healthy humans has been reported in several recent studies, but mechanisms governing their recruitment remain unclear. Dobutamine and dopamine are inotropes commonly used to augment cardiac output; however, both can increase venous admixture/shunt fraction (Qs/Qt). It is possible that, as with exercise, intrapulmonary shunts are recruited with increased cardiac output during dobutamine and/or dopamine infusion that may contribute to the observed increase in Qs/Qt. The purpose of this study was to examine how dobutamine and dopamine affect intrapulmonary shunt and gas exchange. Nine resting healthy subjects received serial infusions of dobutamine and dopamine at incremental doses under normoxic and hyperoxic (inspired O(2) fraction = 1.0) conditions. At each step, alveolar-to-arterial Po(2) difference (A-aDo(2)) and Qs/Qt were calculated from arterial blood gas samples, intrapulmonary shunt was evaluated using contrast echocardiography, and cardiac output was calculated by Doppler echocardiography. Both dobutamine and dopamine increased cardiac output and Qs/Qt. Intrapulmonary shunt developed in most subjects with both drugs and paralleled the increase in Qs/Qt. A-aDo(2) was unchanged due to a concurrent rise in mixed venous oxygen content. Hyperoxia consistently eliminated intrapulmonary shunt. These findings contribute to our present understanding of the mechanisms governing recruitment of these intrapulmonary shunts as well as their impact on gas exchange. In addition, given the deleterious effect on Qs/Qt and the risk of neurological complications with intrapulmonary shunts, these findings could have important implications for use of dobutamine and dopamine in the clinical setting.
Authors:
Tracey L Bryan; Sean van Diepen; Mohit Bhutani; Miriam Shanks; Robert C Welsh; Michael K Stickland
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-06-14
Journal Detail:
Title:  Journal of applied physiology (Bethesda, Md. : 1985)     Volume:  113     ISSN:  1522-1601     ISO Abbreviation:  J. Appl. Physiol.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-16     Completed Date:  2013-01-09     Revised Date:  2013-09-26    
Medline Journal Info:
Nlm Unique ID:  8502536     Medline TA:  J Appl Physiol (1985)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  541-8     Citation Subset:  IM    
Affiliation:
Department of Medicine, Pulmonary Division, University of Alberta, Edmonton, Alberta, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Arterial Pressure / drug effects
Cardiac Output / drug effects
Cardiotonic Agents / administration & dosage*
Dobutamine / administration & dosage*
Dopamine / administration & dosage*
Dose-Response Relationship, Drug
Echocardiography, Doppler
Female
Forced Expiratory Volume / drug effects
Hemodynamics / drug effects*
Humans
Hyperoxia / physiopathology
Infusions, Intravenous
Male
Oxygen Consumption / drug effects
Pulmonary Alveoli / blood supply*,  drug effects*,  physiopathology
Pulmonary Artery / drug effects*,  physiopathology,  ultrasonography
Pulmonary Circulation / drug effects*
Pulmonary Diffusing Capacity / drug effects
Pulmonary Gas Exchange / drug effects*
Time Factors
Vital Capacity / drug effects
Grant Support
ID/Acronym/Agency:
//Canadian Institutes of Health Research
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 34368-04-2/Dobutamine
Comments/Corrections

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


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