Systemic and microcirculatory effects of dobutamine in patients with septic shock

Purpose: The aim of this study was to characterize the cardiovascular responses to dobutamine and their predictors. Our hypotheses were that dobutamine mainly produces tachycardia and vasodilation and fails to improve the microcirculation of patients with septic shock. Materials and Methods: Systemic hemodynamics and sublingual microcirculation were evaluated with dobutamine (0, 2.5, 5.0, and 10.0 mu g kg(-1) min(-1)) in 23 patients with septic shock. Results: Dobutamine increased heart rate, cardiac index, and stroke volume index (SVI). Mean blood pressure was unchanged, and systemic vascular resistance decreased. Individual responses were heterogeneous. Stroke volume index increased in 52% of the patients. These patients showed lower changes in mean blood pressure (3 +/- 16 mm Hg vs -10 +/- 6 mm Hg, P <.05) and higher increases in cardiac index (1.47 +/- 0.93 L m(-1) m(-2) vs 0.20 +/- 0.5 L m(-1) m(-2)) than did nonresponders. Changes in SVI significantly correlated with echocardiographic left ventricular ejection fraction (r = 0.55). In the whole group, perfused capillary density remained unchanged (14.0 +/- 4.3 mm/mm(2) vs 14.8 +/- 3.7 mm/mm(2)), but improved if basal values were 12 mm/mm(2) or less (9.1 +/- 4.3 mm/mm(2) vs 12.5 +/- 4.8 mm/mm(2)). Conclusions: Dobutamine produced variable hemodynamic effects. Systolic dysfunction was the only variable associated with increases in SVI. Finally, dobutamine only improved sublingual microcirculation when severe alterations were found at baseline. (C) 2012 Elsevier Inc. All rights reserved