title: Dobutamine and gastric-to-arterial carbon dioxide gap in severe sepsis without shock.
abstract: 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.
authors.affiliation: Département d'anesthésie-réanimation 2, Hôpital Claude Huriez CHU de Lille, Rue Polonovski, 59037, Lille Cedex, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Lebuffe
authors.forename: Bruno
authors.initials: B
authors.lastname: Levy
authors.forename: Rémy
authors.initials: R
authors.lastname: Nevière
authors.forename: Jean-L
authors.initials: JL
authors.lastname: Chagnon
authors.forename: Pierre-F
authors.initials: PF
authors.lastname: Perrigault
authors.forename: Jacques
authors.initials: J
authors.lastname: Duranteau
authors.forename: Alain
authors.initials: A
authors.lastname: Edouard
authors.forename: Jean-L
authors.initials: JL
authors.lastname: Teboul
authors.forename: Benoit
authors.initials: B
authors.lastname: Vallet
mesh_terms: 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
chemical_list: D002316:Cardiotonic Agents; D007773:Lactates; D002245:Carbon Dioxide; D004280:Dobutamine