Dobutamine and gastric-to-arterial carbon dioxide gap in severe sepsis without shock.
OBJECTIVE
To evaluate the effect of an early dobutamine infusion on gastrointestinal perfusion in patients with severe sepsis.


METHODS
Prospective, randomized, controlled, multicenter clinical study.


METHODS
Six medical and/or surgical intensive care units (ICU) of teaching hospitals.


METHODS
Forty-two patients with severe sepsis.


METHODS
Patients were divided into two groups according to gastric-to-arterial CO2 gap (DeltaCO2) [normal DeltaCO2 group ( n=17): DeltaCO2 < or = 8 mmHg; increased DeltaCO2 group ( n=25): DeltaCO2 > 8 mmHg]. Patients within each group were then randomized to receive either dobutamine (5 microg/kg per min) or saline for 72 h.


RESULTS
SAPS II was similar in both groups [group 1: 44.0 (33.0-56.5); group 2: 48.5 (40.5-59.0), p=0.27]. At ICU admission, mean arterial pressure was lower in the high DeltaCO2 group [73.0 (67.0-79.5) mmHg, p=0.03] than in the normal DeltaCO2 group [84.0 (73.7-104.0) mmHg] while blood lactate [normal DeltaCO2 group: 1.6 (0.8-2.3); high DeltaCO2 group: 1.6 (1.1-1.9) mmol/l] was similar for the two groups. DeltaCO2 was significantly lower in the normal DeltaCO2 group [5.0 (2.0-6.0) mmHg)] than in the high DeltaCO2 group [11.0 (10.0-19.0) mmHg]. Dobutamine infusion did not significantly change hemodynamics, blood lactate concentration or tonometric parameters in any group within the first 72 h and had no particular beneficial effect in this population.


CONCLUSIONS
An early infusion of dobutamine at a fixed dose of 5 microg/kg per min during the first 72 h of severe sepsis does not influence gastric DeltaCO2.
Lebuffe
Gilles
G
Département d'anesthésie-réanimation 2, Hôpital Claude Huriez CHU de Lille, Rue Polonovski, 59037, Lille Cedex, France.
Levy
Bruno
B
Nevière
Rémy
R
Chagnon
Jean-L
JL
Perrigault
Pierre-F
PF
Duranteau
Jacques
J
Edouard
Alain
A
Teboul
Jean-L
JL
Vallet
Benoit
B
D018806:APACHE; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood* / Q000378:metabolism; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004064:Digestive System / Q000378:metabolism*; D004280:Dobutamine / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D007773:Lactates / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D018805:Sepsis / Q000145:classification / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D007773:Lactates; D002245:Carbon Dioxide; D004280:Dobutamine