Comparison of dopamine and dobutamine therapy during intraaortic balloon pumping for the treatment of postcardiotomy low-output syndrome.
Treatment of postcardiotomy low-output syndrome includes intraaortic balloon pumping (IABP), volume loading, pharmacological afterload reduction, and stimulation with an inotropic agent. This study compares the effectiveness of combined nitroprusside and dopamine therapy and nitroprusside and dobutamine therapy in 12 patients requiring IABP postoperatively. Serial hemodynamic measurements were made before and during infusion of nitroprusside and after administration of the combined therapy (N = 6 in each group). Prior to pharmacological therapy, cardiac index was 1.47 +/- 0.31 L/min/m2 and systemic vascular resistance (SVR) was 3,114 +/- 1,350 dynes sec cm-5 in patients subsequently given dopamine, and 1.59 +/- 0.38 L/min/m2 and 2,661 +/- 405 dynes sec cm-5, respectively, in those given dobutamine. With infusion of nitroprusside, both groups showed significant reduction in SVR. Nitroprusside plus either inotropic agent resulted in augmentation of cardiac index and an additional reduction in SVR, both changes being greater in the group given dopamine. Larger doses of dobutamine than dopamine were needed to achieve similar hemodynamic improvement. We conclude that the addition of an inotropic agent to vasodilator therapy during IABP results in a greater increase in cardiac index and a greater decrease in afterload than a vasodilator alone. In addition to its beneficial effect on renal perfusion at the dose required to effect these improvements, dopamine appears a better inotropic agent than dobutamine for postcardiotomy low-output syndrome.
D001021:Aortic Valve / Q000601:surgery; D001243:Assisted Circulation / Q000401:mortality; D002303:Cardiac Output, Low / Q000188:drug therapy / Q000628:therapy*; D002395:Catecholamines / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004280:Dobutamine / Q000008:administration & dosage / Q000627:therapeutic use*; D004298:Dopamine / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005069:Evaluation Studies as Topic; D006322:Heart Aneurysm / Q000601:surgery; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007263:Infusions, Parenteral; D008943:Mitral Valve / Q000601:surgery; D009599:Nitroprusside / Q000008:administration & dosage; D014655:Vascular Resistance / Q000187:drug effects
D002395:Catecholamines; D009599:Nitroprusside; D004280:Dobutamine; D004298:Dopamine