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Terbutaline Infusion in Cardiogenic Shock: Acute Hemodynamic Effects and Clinical Response
Author(s) -
WANG R. Y. C.,
LEE P. K.,
YU D. Y. C.,
TSE T. F.,
CHOW MOSES S. S.
Publication year - 1983
Publication title -
the journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.92
H-Index - 116
eISSN - 1552-4604
pISSN - 0091-2700
DOI - 10.1002/j.1552-4604.1983.tb02748.x
Subject(s) - medicine , cardiac index , cardiogenic shock , heart rate , anesthesia , terbutaline , hemodynamics , cardiac output , blood pressure , vascular resistance , pulmonary wedge pressure , hypokalemia , cardiology , myocardial infarction , asthma
The effect of terbutaline infusion was studied in six patients with cardiogenic shock due to acute myocardial infarction. Terbutaline was initiated at 3 μg/kg/min, and the subsequent infusion rate was adjusted according to heart rate and blood pressure. At 3 hours after infusion, arterial pressure increased from 62 ± 13 mm Hg (mean ± S.D.) to 89 ± 13 mm Hg ( P < 0.001), cardiac index increased from 1.38 ± 0.29 liter/min/m 2 to 2.68 ± 0.47 liter/min/m 2 ( P < 0.001), and heart rate increased from 92 ± 32 beats/min to 112 ± 29 beats/min ( P < 0.005). Pulmonary artery wedge pressure fell from 24 ± 7 mm Hg to 17 ± 3 mm Hg ( P < 0.01), right atrial pressure fell from 12 ± 4 mm Hg to 6 ± 3 mm Hg ( P < 0.005), and systemic vascular resistance fell from 1880 ± 641 dyn‐sec/cm 5 to 1515 ± 418 dyn‐sec/cm 5 ( P < 0.05). In addition, urine flow increased from 4 ± 6 ml/hr to 314 ± 237 ml/hr ( P < 0.05), and subjective improvement was noted in all subjects. Undesirable effects observed were hypokalemia (all subjects), supraventricular tachycardia (one subject), and ventricular ectopic beats (three subjects), which responded to potassium replacement and other treatments. All patients required prolonged maintenance infusion to maintain adequate hemodynamic and clinical response. Four patients were weaned off from maintenance therapy after a mean duration of 4.8 days and eventually were discharged from the hospital. Two patients died, one from cardiogenic shock and one from aspiration pneumonia. This preliminary study indicates that terbutaline infusion produced beneficial hemodynamic and clinical response and may be potentially useful for the management of cardiogenic shock if careful monitoring and potassium replacement are implemented.