Effects of dobutamine and prostacyclin on cerebral blood flow velocity in septic patients.
OBJECTIVE
Both dobutamine and prostacyclin (PGI2) have been used to increase oxygen delivery in septic patients, but their effects on cerebral blood flow have not been well studied.


METHODS
In 10 septic patients with altered mental status, stable hemodynamic status, and normal lactatemia, we investigated the effects of successive infusions of dobutamine at 5 micrograms/kg/min and PGI2 at 5 ng/kg/min on mean blood flow velocity in a middle cerebral artery, using transcranial Doppler flowmetry.


RESULTS
Mean flow velocity increased with dobutamine (from 52 +/- 4 to 62 +/- 6 cm/s, P < .005) but not with PGI2 (from 55 +/- 5 to 57 +/- 5 cm/s, P = not significant). Each substance significantly increased cardiac index. Dobutamine increased arterial pressure from 85 +/- 6 to 91 +/- 5 mm Hg (P < .05), but PGI2 decreased it from 87 +/- 6 to 77 +/- 5 mm Hg (P < .005). With each agent, mean flow velocity was correlated with cardiac index (r = .51, P < .001) but not with arterial pressure. PGI2 reduced PaO2 from 103 +/- 10 to 82 +/- 6 mm Hg (P < .005). Cerebral oxygen delivery (estimated by the product of mean flow velocity and arterial oxygen content) increased by 19% with dobutamine but remained unchanged with PGI2.


CONCLUSIONS
Dobutamine and PGI2 at the administered doses exert different effects on arterial pressure and middle cerebral artery flow velocity in septic patients. According to these data, dobutamine increases cerebral oxygen delivery more than PGI2.
Berré
J
J
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
De Backer
D
D
Moraine
J J
JJ
Vincent
J L
JL
Kahn
R J
RJ
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001783:Blood Flow Velocity / Q000187:drug effects; D002536:Cerebral Arteries / Q000187:drug effects / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004280:Dobutamine / Q000494:pharmacology*; D011464:Epoprostenol / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007239:Infections / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D007262:Infusions, Intravenous; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects; D015996:Survival Rate; D017585:Ultrasonography, Doppler, Transcranial
D004280:Dobutamine; D011464:Epoprostenol