Dobutamine reverses the vasopressin-associated impairment in cardiac index and systemic oxygen supply in ovine endotoxemiaReportar como inadecuado




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Critical Care

, 10:R144

First Online: 10 October 2006Received: 05 October 2006Accepted: 10 October 2006

Abstract

IntroductionArginine vasopressin AVP is increasingly used to treat sepsis-related vasodilation and to decrease catecholamine requirements. However, AVP infusion may be associated with a marked decrease in systemic blood flow and oxygen transport. The purpose of the present study was to evaluate whether dobutamine may be titrated to reverse the AVP-related decrease in cardiac index CI and systemic oxygen delivery index DO2I in an established model of ovine endotoxemia.

MethodsTwenty-four adult ewes were chronically instrumented to determine cardiopulmonary hemodynamics and global oxygen transport. All ewes received a continuous endotoxin infusion that contributed to a hypotensive-hyperdynamic circulation and death of five sheep. After 16 hours of endotoxemia, the surviving ewes n = 19; weight 35.6 ± 1.5 kg mean ± SEM were randomized to receive either AVP 0.04 Umin and dobutamine n = 8 or the vehicle normal saline; n = 6 and compared with a third group treated with AVP infusion alone n = 5. Dobutamine infusion was started at an initial rate of 2 μg kgmin and was increased to 5 and 10 μg kg min after 30 and 60 minutes, respectively.

ResultsAVP infusion increased mean arterial pressure MAP and systemic vascular resistance index at the expense of a markedly decreased CI 4.1 ± 0.5 versus 8.2 ± 0.3 l min m, DO2I 577 ± 68 versus 1,150 ± 50 ml min m and mixed-venous oxygen saturation SvO2; 54.5 ± 1.8% versus 69.4 ± 1.0%; all p < 0.001 versus control. Dobutamine dose-dependently reversed the decrease in CI 8.8 ± 0.7 l min m versus 4.4 ± 0.5 l min m, DO2I 1323 ± 102 versus 633 ± 61 ml min m and SvO2 72.2 ± 1.7% versus 56.5 ± 2.0%, all p < 0.001 at dobutamine 10 μg kg min versus AVP group and further increased MAP.

ConclusionThis study provides evidence that dobutamine is a useful agent for reversing the AVP-associated impairment in systemic blood flow and global oxygen transport.

AbbreviationsAVPAVP = arginine vasopressin

CICI = cardiac index

DODO2I = oxygen delivery index

HRHR = heart rate

LVSWILVSWI = left ventricular stroke work index

MAPMAP = mean arterial pressure

MPAPMPAP = mean pulmonary arterial pressure

OO2-ER = oxygen extraction rate

PAOPPAOP = pulmonary arterial occlusion pressure

PVRIPVRI = pulmonary vascular resistance index

RVSWIRVSWI = right ventricular stroke work index

SSvO2 = mixed-venous oxygen saturation

SVRISVRI = systemic vascular resistance index

VOVO2I = oxygen consumption index.

Electronic supplementary materialThe online version of this article doi:10.1186-cc5065 contains supplementary material, which is available to authorized users.

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Autor: Christian Ertmer - Andrea Morelli - Hans-Georg Bone - Henning Dirk Stubbe - Ralf Schepers - Hugo Van Aken - Matthias Lange

Fuente: https://link.springer.com/







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