Comparison Of Dopamine To Dobutamine And Norepinephrine For Oxygen Delivery And Uptake In Septic Shock

Title

Comparison Of Dopamine To Dobutamine And Norepinephrine For Oxygen Delivery And Uptake In Septic Shock

Creator

Hannemann L; Reinhart K; Grenzer O; Meierhellmann A; Bredle D L

Publisher

Critical Care Medicine

Date

1995
1995-12

Description

Objectives: To test whether dopamine infusion improves oxygen delivery (D over dot O-2) and oxygen uptake (V over dot O-2) in hyperdynamic septic shock patients stabilized by adequate volume and dobutamine alone, or by the combination of dobutamine and norepinephrine. Design: Prospective clinical trial of two patient groups. Group 1 (n = 15) was stabilized with dobutamine, and group 2 (n = 10) was stabilized with dobutamine and norepinephrine. Setting: Intensive care unit in a university hospital. Patients: Twenty-five postoperative, hyperdynamic septic shock patients. Interventions: The stabilizing catecholamine infusion was replaced in a stepwise manner by dopamine to achieve a similar mean arterial pressure (dopamine doses: group 1, mean 22 +/- 15 mu g/kg/min [range 6 to 52]; and group 2, mean 57 +/- 41 mu g/kg/min [range 15 to 130]). Measurements and Main Results: A complete hemodynamic profile was performed with oxygen transport-related variables at baseline, after replacement by dopamine and after resetting to the original catecholamine infusion. The change to dopamine resulted in increases in cardiac index (group 1: 20% [p < .01]; group 2: 33% [p < .01]), and D over dot O-2 (group 1: 19% [p < .01]; group 2: 27% [p < .01]). However, V over dot O-2, whether directly measured from the respiratory gases or calculated by the cardiovascular Fick principle, did not change in both groups with dopamine, while the oxygen extraction ratio decreased significantly in both groups with dopamine. Heart rate, pulmonary artery occlusion pressure, and pulmonary shunt fraction all increased with dopamine, Pao(2) decreased, but oxygen saturation remained stable in both groups with dopamine. Conclusions: Short-term dopamine infusion in hyperdynamic septic shock patients, de. spite producing higher global D over dot O-2, was not superior to dobutamine or the combination of dobutamine and norepinephrine infusion.

Subject

agents; cardiac-output; catecholamines; consumption; dobutamine; dopamine; General & Internal Medicine; hemodynamics; infusion; inotropic; intra-pulmonary shunt; lactic-acidosis; norepinephrine; oxygen consumption; septic shock; severe sepsis; skeletal-muscle; therapy; transport

Format

Journal Article or Conference Abstract Publication

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Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

1962-1970

Issue

12

Volume

23

Citation

Hannemann L; Reinhart K; Grenzer O; Meierhellmann A; Bredle D L, “Comparison Of Dopamine To Dobutamine And Norepinephrine For Oxygen Delivery And Uptake In Septic Shock,” NEOMED Bibliography Database, accessed July 23, 2021, https://neomed.omeka.net/items/show/10071.

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