Effects of dobutamine on oxygen transport and consumption in the adult respiratory distress syndrome.
OBJECTIVE
To determine if oxygen consumption (VO2) in patients with adult respiratory distress syndrome (ARDS) is dependent on, and thus limited by, oxygen transport (TO2) rather than O2 demand.


METHODS
Prospective study.


METHODS
Intensive care unit of a tertiary referral center.


METHODS
12 patients with ARDS and sepsis syndrome.


METHODS
Routine intensive care unit monitoring including pulmonary and radial artery catheters.


METHODS
Dobutamine was used to increase cardiac output, thereby directly varying TO2 under conditions of constant O2 demand. After baseline measurements of TO2 and VO2, dobutamine was infused intravenously at progressively increasing doses of 5, 10, 15 and 20 micrograms/kg/min and measurements of TO2 and VO2 were repeated after 30 min at each dose.


RESULTS
Dobutamine increased TO2 in 8 of the 12 patients, by 29% at 5 micrograms/kg/min and by 45% (net) at 10 micrograms/kg/min, but not at higher doses. In these 8 patients dobutamine also increased VO2 by 15% at 5 micrograms/kg/min, but did not further increase VO2 at higher doses. There was no correlation between baseline blood lactate concentration and the response of either TO2 or VO2 to dobutamine.


CONCLUSIONS
In some but not all patients with ARDS and sepsis syndrome, short-term infusion of low-dose dobutamine can increase both TO2 and VO2. Achievement of a TO2-independent level of VO2 could not be convincingly demonstrated in any individual patient. The response of TO2 and VO2 to dobutamine could not be predicted from baseline blood lactate concentration. Determination of the impact on patient outcome of a more prolonged infusion of dobutamine requires further study.
Krachman
S L
SL
Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston.
Lodato
R F
RF
Morice
R
R
Gutierrez
G
G
Dantzker
D R
DR
D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D004280:Dobutamine / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007239:Infections / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D007262:Infusions, Intravenous; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood* / Q000493:pharmacokinetics*; D010101:Oxygen Consumption / Q000187:drug effects*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D014018:Tissue Distribution
D007773:Lactates; D019344:Lactic Acid; D004280:Dobutamine; D010100:Oxygen