The effects of dobutamine therapy in critically ill patients measured by transoesophageal echocardiography and intracardiac monitoring.
Fourteen patients with severe hypotension and adult respiratory distress syndrome after trauma (n = 7), general surgery (n = 6) or burns (n = 1) were studied. After volume loading with 6 ml.kg-1 hydroxyethyl starch over 30 min (time I), dobutamine was infused intravenously at 5 micrograms.kg-1.min-1 (time II) and 10 micrograms.kg-1.min-1 (time III). A 5 MHz transoesophageal echocardiographic probe was used to image a standard transgastric short axis view of the left ventricle. Haemodynamic data were obtained from thermodilution studies using pulmonary flotation catheterisation. Echocardiographic measurements (off-line from videotape) and qualitative visual assessment of left ventricular function (visual assessment, on-line) were performed. All measurements were made after fluid replacement, and during infusion of the two dobutamine doses. An improvement in mean systemic arterial blood pressure and mean stroke volume occurred from time I to the end of dobutamine infusion (p < 0.05). All patients, after volume infusion, were normovolaemic according to transoesophageal echocardiography and there was a good correlation between end-diastolic area and stroke volume (r = 0.73). During dobutamine infusion, echocardiographic measurements showed no significant dose-related increase in mean (SD) percentage left ventricular short axis area change from baseline after hydroxyethyl starch (time I: 60 (2); time II: 63 (2); time III: 64 (2)). However, a significant increase in short axis area change was seen in nine of the 14 patients (67%). Analysis of the end-diastolic area/short axis area change relationship revealed a heterogeneous response to dobutamine.(ABSTRACT TRUNCATED AT 250 WORDS)
Steltzer
H
H
Department of Anaesthesia, University of Vienna, Austria.
Simon
P
P
Owen
A N
AN
Thalmann
M
M
Hammerle
A F
AF
D000328:Adult; D006328:Cardiac Catheterization; D004280:Dobutamine / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy*
D004280:Dobutamine