Open AccessEMPLOYING DOBUTAMINE AS A USEFUL AGENT TO REVERSE THE TERLIPRESSIN-LINKED IMPAIRMENTS IN CARDIOPULMONARY HEMODYNAMICS AND GLOBAL OXYGEN TRANSPORT IN HEALTHY AND ENDOTOXEMIC SHEEP
Author(s) -
Katrin Bröking,
Matthias Lange,
Andrea Morelli,
Christian Ertmer,
Hugo Van Aken,
Martin Luecke,
Sebastian Rehberg,
Norman Böwering,
Hans-Georg Bone,
Daniel L. Traber,
Martin Westphal
Publication year - 2008
Publication title -
shock
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.095
H-Index - 117
eISSN - 1540-0514
pISSN - 1073-2322
DOI - 10.1097/shk.0b013e318063e63b
Subject(s) - terlipressin , dobutamine , medicine , anesthesia , septic shock , oxygen transport , hemodynamics , esmolol , bolus (digestion) , cardiac index , blood pressure , sepsis , cardiac output , heart rate , oxygen , hepatorenal syndrome , chemistry , ascites , organic chemistry
Although arginine vasopressin and terlipressin have been identified as useful nonadrenergic agents to increase systemic blood pressure in catchecholamine-resistant septic shock, the impairments in cardiac index (CI) and global oxygen transport may limit their clinical applicability. The present study was designed as a prospective controlled laboratory experiment to investigate the effects of dobutamine as an adjunct to terlipressin infusion on cardiopulmonary hemodynamics and global oxygen transport in healthy and endotoxemic sheep. Nine adult ewes were instrumented for chronic study using an established protocol. After a baseline measurement in the healthy state had been performed, 1 mg terlipressin was given as bolus infusion. Thirty minutes later, dobutamine was continuously infused at incremental doses (2 and 5 microg x kg(1) x min(1), each for 1 h). After 24 h of recovery, a hypotensive-hyperdynamic circulation was induced and maintained by a continuous infusion of Salmonella typhosa endotoxin (10 ng x kg(1) x min(1)). After 16 h of endotoxemia, the six surviving sheep received terlipressin and dobutamine according to the same protocol that was used in healthy sheep. Compared with baseline, terlipressin infusion was associated with a significant increase in MAP that, however, occurred at the expense of a compromised CI, oxygen delivery index (DO(2)I), and mixed venous oxygen saturation (SvO(2), each P < 0.05). Dobutamine infusion was followed by a dose-dependent increase in CI, DO(2)I, and SvO(2) in both health and endotoxemia (each P < 0.05). Although the higher dosage of dobutamine exerted favorable effects, such as a decrease in pulmonary vascular resistance index (P < 0.05), the associated onset of tachycardia (P < 0.05) and arterial hypotension (P < 0.05) may limit its therapeutic use under septic conditions. This study provides evidence that dobutamine in a dosage of 2 microg x kg(1) x min(1) is useful to reverse the terlipressin-linked depressions in CI, DO(2)I and SvO(2) in ovine endotoxemia without obvious side effects.