Epinephrine versus dopamine to treat shock in hypoxic newborn pigs resuscitated with 100% oxygen.
Shock and tissue hypoperfusion are common after asphyxia. We compared systemic and regional hemodynamic effects of epinephrine and dopamine in the treatment of shock and hypotension in asphyxiated newborn piglets resuscitated with 100% oxygen. Twenty-four piglets (1-3 days old; weight, 1.4-2.6 kg) were acutely instrumented to measure cardiac index (CI), carotid, mesenteric and renal arterial blood flows, and mean systemic (SAPs) and pulmonary arterial pressures (PAPs). Piglets had normocapnic alveolar hypoxia (F(IO2)=0.08-0.10) for 50 min and reoxygenated with F(IO2)=1.0 for 1 h then F(IO2)=0.21 for 3.5 h. After 2 h reoxygenation, either dopamine (2 microg kg(-1) min(-1)) or epinephrine (0.2 microg kg(-1) min(-1)) was given for 30 min in a blinded randomized manner, which was then increased to maintain SAP (within 10% of baseline, pressure-driven dose) for 2 h. Hypoxia caused hypotension (SAP, 44%+/-3% of baseline), cardiogenic shock (CI, 41%+/-4%), and metabolic acidosis (mean pH, 7.04-7.09). Upon reoxygenation, hemodynamic parameters immediately recovered but gradually deteriorated during 2 h with SAP at 45+/-1 mmHg, CI at 74+/-9% of baseline, and pH 7.32+/-0.03. Low doses of either drug had no significant systemic and renal hemodynamic response. Epinephrine (0.3-1.5 microg kg(-1) min(-1)) for 2 h increased SAP and CI (with higher stroke volume) and decreased pulmonary vascular resistance (with reduced PAP-SAP ratio), whereas the responses with dopamine (10-25 microg kg(-1) min(-1)) were modest. Low-dose epinephrine improved mesenteric and carotid arterial flows, whereas the pressure-driven doses of epinephrine and dopamine increased carotid and mesenteric arterial flows, respectively. To treat shock in asphyxiated newborn piglets resuscitated with 100% oxygen, epinephrine exhibits an inotropic action compared with dopamine, whereas both catecholamines can increase carotid and mesenteric perfusion.
Obaid
Laila
L
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Johnson
Scott T
ST
Emara
Marwan
M
Bigam
David L
DL
Cheung
Po-Yin
PY
D000818:Animals; D000831:Animals, Newborn; D001692:Biological Transport / Q000187:drug effects; D002395:Catecholamines / Q000494:pharmacology; D004298:Dopamine / Q000494:pharmacology*; D004837:Epinephrine / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects; D000860:Hypoxia / Q000503:physiopathology; D010100:Oxygen / Q000378:metabolism*; D011652:Pulmonary Circulation / Q000187:drug effects; D012151:Resuscitation / Q000379:methods*; D012769:Shock / Q000188:drug therapy* / Q000503:physiopathology; D013552:Swine
D002395:Catecholamines; D010100:Oxygen; D004298:Dopamine; D004837:Epinephrine