Hannemann L; Reinhart K; Meierhellmann A; Wallenfang G; Bredle D L
Publisher
Chest
Date
1996
1996-03
Description
Objective: To test whether dopexamine hydrochloride, by its beta(2)-adrenoceptor and dopaminergic 1 (DA(1)) and dopaminergic 2 (DA(2)) agonistic properties, can improve oxygen consumption (V over dot O-2) in hyperdynamic patients with septic shock. Design: Prospective, single-cohort study. Setting: ICU, university hospital. Patients: Twenty-nine postoperative, hemodynamically stabilized, hyperdynamic patients with septic shock. Interventions: Short-term application (30 min) of dopexamine hydrochloride at a dose of 2 mu g/kg/min. Measurements: Complete hemodynamic profile with O-2 transport-related variables at baseline, 30 min after starting the dopexamine infusion, and 30 min after stopping the infusion. Main results: The dopexamine infusion resulted in significant increases in cardiac index (17%) (p<0.001) and O-2 delivery (DO2) (16%) (p<0.001), V over dot O-2 increased slightly but significantly about 4% (p<0.01) by respiratory gas exchange measurements and 9% (p<0.01) by cardiovascular Fick calculations. The O-2 extraction ratio decreased about 8% (0.001). Conclusions: The addition of dopexamine hydrochloride at a dose of 2 mu g/kg/min resulted in significant increases of DO2 and to a lesser extent V over dot O-2. Much of the global DO2 increase was not utilized, because O-2 extraction ratio decreased. Direct calorigenic effects of dopexamine and an increase in myocardial V over dot O-2 likely account for a large portion of the increase in global V over dot O-2. Whether any of the V over dot O-2 increase reflects improvement in regions of jeopardized tissue oxygenation remains to be clarified before the definite value of this lug in septic shock can be established.