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Arginine vasopressin (AVP) is increasingly used to treat sepsis-related vasodilation and to decrease catecholamine requirements. However, AVP infusion may be associated with a marked decrease in systemic blood flow and oxygen transport. The purpose of the present study was to evaluate whether dobutamine may be titrated to reverse the AVP-related decrease in cardiac index (CI) and systemic oxygen delivery index (DO 2 I) in an established model of ovine endotoxemia.    Methods  Twenty-four adult ewes were chronically instrumented to determine cardiopulmonary hemodynamics and global oxygen transport. All ewes received a continuous endotoxin infusion that contributed to a hypotensive-hyperdynamic circulation and death of five sheep. After 16 hours of endotoxemia, the surviving ewes ( n  = 19; weight 35.6 ± 1.5 kg (mean ± SEM)) were randomized to receive either AVP (0.04 Umin -1 ) and dobutamine ( n  = 8) or the vehicle (normal saline;  n  = 6) and compared with a third group treated with AVP infusion alone ( n  = 5). Dobutamine infusion was started at an initial rate of 2 μg kg -1 min -1  and was increased to 5 and 10 μg kg -1  min -1  after 30 and 60 minutes, respectively.    Results  AVP infusion increased mean arterial pressure (MAP) and systemic vascular resistance index at the expense of a markedly decreased CI (4.1 ± 0.5 versus 8.2 ± 0.3 l min -1  m -2 ), DO 2 I (577 ± 68 versus 1,150 ± 50 ml min -1  m -2 ) and mixed-venous oxygen saturation (S v O 2 ; 54.5 ± 1.8% versus 69.4 ± 1.0%; all  p  < 0.001 versus control). Dobutamine dose-dependently reversed the decrease in CI (8.8 ± 0.7 l min -1  m -2  versus 4.4 ± 0.5 l min -1  m -2 ), DO 2 I (1323 ± 102 versus 633 ± 61 ml min -1  m -2 ) and S v O 2  (72.2 ± 1.7% versus 56.5 ± 2.0%, all  p  < 0.001 at dobutamine 10 μg kg -1  min -1  versus AVP group) and further increased MAP.    Conclusion  This study provides evidence that dobutamine is a useful agent for reversing the AVP-associated impairment in systemic blood flow and global oxygen transport.

Dobutamine reverses the vasopressin-associated impairment in cardiac index and systemic oxygen supply in ovine endotoxemia.