Haemodynamic changes in neurogenic pulmonary oedema: effect of dobutamine.
The haemodynamic and gas exchange abnormalities occurring in neurogenic pulmonary oedema (NPO) were examined retrospectively in 20 patients admitted to the Intensive Therapy Unit (ITU) over a 45-month period (February 1992 to November 1995). In 12 patients, where vasoactive therapy with dobutamine was employed, its effect on haemodynamics was examined. Cardiac index (CI median 2.2 l min-1 m-2) and left ventricular stroke work index (LVSWI 20 g.m.m-2) were markedly depressed, while pulmonary artery wedge pressure (PAWP 17 mmHg), mean pulmonary artery pressure (MPAP 30.5 mmHg), systemic vascular resistance index (SVRI 2852 dyne.s.cm-5.m2) and pulmonary vascular resistance index (PVRI 393 dyne.s.cm-5.m2) were substantially elevated above normal values. Mean arterial pressure (MAP 82.5 mmHg) and heart rate (HR 102 bpm) were within normal limits. The poor oxygenation is indicated by a median PaO2/fiO2 ratio of 18.0 kPa. Patients treated with dobutamine showed significant increases in CI and LVSWI and significant falls in SVRI and PAWP at 2 and 6 h after institution of therapy, and there was a significant rise in PaO2/fiO2 ratio to 27.8 kPa at 6 h. NPO was generally associated with severe depression of myocardial function and elevation of pulmonary vascular pressures. This dysfunction was readily reversed by dobutamine.
Deehan
S C
SC
Intensive Therapy Unit, Western General Hospital Edinburgh, UK.
Grant
I S
IS
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications*; D002648:Child; D004280:Dobutamine / Q000627:therapeutic use*; D016903:Drug Monitoring; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D011654:Pulmonary Edema / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013566:Sympathomimetics / Q000627:therapeutic use*; D018487:Ventricular Dysfunction, Left / Q000150:complications
D013566:Sympathomimetics; D004280:Dobutamine