Dopamine, dobutamine, and phentolamine effects on pulmonary vascular mechanics

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Abstract
The pressure-flow (P-Q) relationship of the pulmonary vasculature, in an isolated canine lobe perfused under classical zone II conditions, can be characterized by a rectilinear segment at high flow, a curvilinear segment at low flow, and a pulmonary arterial pressure (Ppa) that exceeds alveolar pressure at zero flow. This demonstrates the presence of critical closure in the pulmonary vascular bed. Effects of drugs on pulmonary vascular resistance (PVR) must take the normal P-Q relationship into account. We examined the effect of dopamine (D) and dobutamine (DB), alone and in combination with phentolamine (P), on the slope of the rectilinear segment of the P-Q curve (equivalent to vascular conductance), the extrapolated Ppa intercept (Ppai), and the Ppa at zero flow (Ppaz). Low-dose D (0.4–0.8 mg) and DB (1.0–5.0 mg) did not significantly alter any parameter from control. Higher-dose D (1.2–6.8 mg) and DB (13–38 mg) decreased vascular conductance 32.3 +/- 12.1 (SE) to 50.45 +/- 5.6% (P less than 0.05), and P alone increased conductance 12.0 +/- 2.6% (P less than 0.01) from control with no significant effect on Ppai or Ppaz. The change in conductance with D and DB alone was abolished when either drug was given in combination with P. Ppaz and Ppai decreased significantly from control with DB in combination with P when no significant effect on vascular conductance was noted. The results suggest that lung vessels determining changes in flow resistance are pharmacologically distinct from those subserving critical closure in the pulmonary vascular bed.

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