Dobutamine improves the adequacy of gastric mucosal perfusion in epinephrine-treated septic shock

Publisher Website
Google Scholar
Abstract
To assess the effects of dobutamine at a rate of 5 micro g/kg/min on hemodynamics and gastric intramucosal acidosis in patients with hyperdynamic septic shock treated with epinephrine. A prospective, interventional, clinical trial. An adult, 16-bed medical/surgical intensive care unit of a university hospital. Twenty septic shock patients with a mean arterial pressure of >75 mm Hg and a cardiac index of >3.5 L/min/m2. After baseline measurements (H0), each patient received dobutamine at a rate of 5 micro g/kg/min. Baseline measurements included: hemodynamic parameters, tonometric parameters, arterial and mixed venous gases, and arterial lactate concentrations. These measurements were repeated after 1 (H1), 2 (H2), and 3 (H3) hrs. After H2 measurements, dobutamine was stopped. The patients were separated into two groups according to their PCO2 gap (tonometer PCO2 - PaCO2). The increased PCO2 gap group was defined by a PCO2 gap >8 torr (>1.1 kPa) (n = 13), and the normal PCO2 gap group by a PCO2 gap Dobutamine at 5 micro g/kg/min had no significant effects on mean arterial pressure, heart rate, cardiac index, systemic vascular resistance, oxygen delivery, and oxygen consumption in epinephrine-treated septic shock. No patients developed arrhythmia or electrocardiographic signs of myocardial ischemia. During dobutamine infusion, arterial lactate concentration decreased from 5.1 +/- 0.4 in the increased PCO2 gap group and 4.2 +/- 0.4 in the normal PCO2 gap group to 3.9 +/- 0.3 and 3.5 +/- 0.3 mmol/L, respectively (p 2 The addition of 5 micro g/kg/min of dobutamine added to epinephrine in hyperdynamic septic shock selectively improved the adequacy of gastric mucosal perfusion without modification in systemic hemodynamics. (Crit Care Med 1997; 25:1649-1654)