title: Effect of dobutamine on extravascular lung water index, ventilator function, and perfusion parameters in acute respiratory distress syndrome associated with septic shock.
abstract: BACKGROUND
  The role of dobutamine in the relief of pulmonary edema during septic shock-induced acute respiratory distress syndrome (ARDS) remains undetermined, due to a lack of controllable and quantitative clinical studies. Our objective was to assess the potential effects of dobutamine on extravascular lung water index (ELWI) in septic shock-induced ARDS, reflecting its importance in pulmonary edema. At the same time, ventilator function and perfusion parameters were evaluated.
  
  
  METHODS
  We designed a prospective, non-randomized, non-blinded, controlled study to compare the differences in PiCCO parameters after 6 h of constant dobutamine infusion (15 μg/kg/min), in the baseline parameters in 26 septic shock-related ARDS patients with cardiac index ≥ 2.5I/min/m(2) and hyperlactatemia. These patients (12 survivors/14 non-survivors) were monitored using the PiCCO catheter system within 48 h of onset of septic shock. The dynamic changes in ELWI, which is typically used for quantifying the extent of pulmonary edema, were evaluated, and the corresponding ventilator function and tissue perfusion parameters were also measured.
  
  
  RESULTS
  Decreasing ELWI (p = 0.0376) was accompanied by significantly decreased SVRI (p < 0.0001). Despite a significant increase in cardiac output (p < 0.0001), no differences were found in ITBI or GEDI. Moreover, the required dose of norepinephrine was decreased (p = 0.0389), and urine output was increased (p = 0.0358), accompanied by stabilized lactacidemia and MAP. Additionally, airway pressure was moderately improved.
  
  
  CONCLUSIONS
  During the early stage of septic shock-induced ARDS, dobutamine treatment demonstrated a beneficial effect by relieving pulmonary edema in patients, without a negative elevation in preload or hemodynamics, which might account for the improvements in ventilator function and tissue hypoperfusion.
authors.affiliation: a Department of Critical Care Medicine , the First Affiliated Hospital of Anhui Medical University , Anhui , China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhou
authors.affiliation: b Department of Critical Care Medicine , the Affiliated Yixing People's Hospital of Jiangsu University , Jiangsu , China.
authors.forename: Ji
authors.initials: J
authors.lastname: Dai
authors.affiliation: a Department of Critical Care Medicine , the First Affiliated Hospital of Anhui Medical University , Anhui , China.
authors.forename: Min
authors.initials: M
authors.lastname: Du
authors.affiliation: a Department of Critical Care Medicine , the First Affiliated Hospital of Anhui Medical University , Anhui , China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: c Department of Emergency and Critical Care Medicine , Shanghai Changzheng Hospital , Shanghai , China.
authors.forename: Changxing
authors.initials: C
authors.lastname: Guo
authors.affiliation: d Department of Emergency and Critical Care Medicine , the People's Hospital of Hangzhou City , ZheJiang , China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: a Department of Critical Care Medicine , the First Affiliated Hospital of Anhui Medical University , Anhui , China.
authors.forename: Rui
authors.initials: R
authors.lastname: Tang
authors.affiliation: a Department of Critical Care Medicine , the First Affiliated Hospital of Anhui Medical University , Anhui , China.
authors.forename: Fengling
authors.initials: F
authors.lastname: Xu
authors.affiliation: e Department of Anesthesiology , the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital , Jiangsu , China.
authors.forename: Zhuqing
authors.initials: Z
authors.lastname: Rao
authors.affiliation: f Department of Respiratory Medicine , the First Affiliated Hospital of Anhui Medical University , Anhui , China.
authors.forename: Gengyun
authors.initials: G
authors.lastname: Sun
mesh_terms: D000328:Adult; D000368:Aged; D004280:Dobutamine / Q000008:administration & dosage*; D015633:Extravascular Lung Water; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012772:Shock, Septic / Q000150:complications / Q000503:physiopathology / Q000628:therapy
chemical_list: D004280:Dobutamine
keywords: acute respiratory distress syndrome; dobutamine; extravascular lung water; pulmonary edema; septic shock