Heterogeneity and prediction of hemodynamic responses to dobutamine in patients with septic shock
| Autor: | Jellema, W.T., Groeneveld, A.B.J., Wesseling, K.H., Thijs, L.G., Westerhof, N., Lieshout, J.J. van |
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| Jazyk: | angličtina |
| Rok vydání: | 2006 |
| Předmět: |
Cardiac output
Adult Male heart muscle oxygen consumption Cardiotonic Agents Systole systemic vascular resistance maximum permissible dose Blood Pressure hemodynamics intensive care unit Ventricular Function Left Catecholamines Diastole Heart Rate Sepsis Septic shock Dobutamine Humans human Prospective Studies Infusions Intravenous Aorta APACHE Aged clinical article chronotropism Dose-Response Relationship Drug Middle Aged Shock Septic venous oxygen tension Oxygen Critical care Intensive Care Units inotropism heart stroke volume mean arterial pressure Female Vascular Resistance heart index |
| Zdroj: | Critical Care Medicine, 9, 34, 2392-2398 |
| Popis: | 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 μg·kg· min with subsequent increments to 8, 12.6, and 20 μg·kg·min, on two consecutive days. Responses were dichotomized into changes in heart rate (HR) or stroke volume index (SVI) of >10% and ≤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 ΔHR > 10% vs. ΔHR ≤ 10%, baseline HR was lower, and baseline mixed venous oxygen tension and saturation were higher. During dobutamine infusion, mean arterial pressure decreased in ΔHR > 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) without changes in SVI or cardiac index. Baseline hemodynamic and metabolic variables did not differ between SVI groups. In ΔSVI > 10%, cardiac index increased with dobutamine, but Pao2 and the systemic oxygen delivery index decreased. In ΔSVI ≤ 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. Copyright © 2006 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. Chemicals / CAS: dobutamine, 34368-04-2, 52663-81-7; Cardiotonic Agents; Dobutamine, 34368-04-2; Oxygen, 7782-44-7Chemicals / CAS: dobutamine, 34368-04-2, 52663-81-7; Cardiotonic Agents; Dobutamine, 34368-04-2; Oxygen, 7782-44-7 |
| Databáze: | OpenAIRE |
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