Goal-directed therapy with dopexamine, dobutamine, and volume expansion

Tighe, D.; Moss, R.; G, Heywood; Al-Saady, N.; Webb, A.I.; Bennett, David

doi:10.1097/00003246-199512000-00008

Cited by 56 publications

(9 citation statements)

References 19 publications

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“…Similarly, some of the studies showed an increase in heart rate in a dose-dependent manner [5], [9], [11]–[13], [16], [18], [23], [26], [28]. An increase in stroke volume was mainly observed in studies using prolonged infusion (from 2 to 6 h) at doses higher than 10 µg/kg/min [6], [8], [9], [17].…”

Section: Resultsmentioning

confidence: 85%

“…Some found no changes in arterial blood pressure [7]–[9], [17], [20], [24], [28], but in a few studies the arterial blood pressure increased at the highest dose studied [6], [11], [19], [26], [27]. Similarly, some of the studies showed an increase in heart rate in a dose-dependent manner [5], [9], [11]–[13], [16], [18], [23], [26], [28].…”

Section: Resultsmentioning

confidence: 97%

“…In this regard, most authors agree that dobutamine infusion improves cardiac output mainly at doses higher than 10 µg/kg/min [6], [8]–[14], [16]–[19]. It seems that at short term infusion this improvement was mainly due to an increase in heart rate [9], [11], [12], [16], [18], whereas at long term the increment in stroke volume is more prevalent [6], [8], [9], [17].…”

Section: Resultsmentioning

confidence: 97%

“…Only one of the studies included was blinded [6], while randomization was reported in 42% of the studies [6]–[9], [11], [13], [14], [16], [17], [20]. Similarly, 42% of the studies used a control group [5]–[8], [12], [13], [15], [17], [21], [22].…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, 42% of the studies used a control group [5]–[8], [12], [13], [15], [17], [21], [22]. Some studies assessed the effects of dobutamine by comparison with baseline data and/or the effect of other drugs.…”

Section: Resultsmentioning

confidence: 99%

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Dobutamine in Paediatric Population: A Systematic Review in Juvenile Animal Models

2014

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ObjectiveAlthough dobutamine is widely used in neonatal clinical practice, the evidence for its use in this specific population is not clear. We conducted a systematic review of the use of dobutamine in juvenile animals to determine whether the evidence from juvenile animal experiments with dobutamine supported the design of clinical trials in neonatal/paediatric population.MethodsStudies were identified by searching MEDLINE (1946–2012) and EMBASE (1974–2012). Articles retrieved were independently reviewed by three authors and only those concerning efficacy and safety of the drug in juvenile animals were included. Only original articles published in English and Spanish were included.ResultsFollowing our literature search, 265 articles were retrieved and 24 studies were included in the review: 17 focused on neonatal models and 7 on young animal models. Although the aims and design of these studies, as well as the doses and ages analysed, were quite heterogeneous, the majority of authors agree that dobutamine infusion improves cardiac output in a dose dependent manner. Moreover, the cardiovascular effects of dobutamine are influenced by postnatal age, as well as by the dose used and the duration of the therapy. There is inadequate information about the effects of dobutamine on cerebral perfusion to draw conclusions.ConclusionThere is enough preclinical evidence to ensure that dobutamine improves cardiac output, however to better understand its effects in peripheral organs, such as the brain, more specific and well designed studies are required to provide additional data to support the design of clinical trials in a paediatric population.

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Section: Resultsmentioning

confidence: 85%

Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Dobutamine in Paediatric Population: A Systematic Review in Juvenile Animal Models

2014

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Liver Perfusion in Sepsis, Septic Shock, and Multiorgan Failure

Spapen

2008

The Anatomical Record

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Sepsis causes significant alterations in the hepatic macro-and microcirculation. Diverging views exist on global hepatic blood flow during experimental sepsis because of the large variety in animal and sepsis models. Fluid-resuscitated clinical sepsis is characterized by ongoing liver ischemia due to a defective oxygen extraction despite enhanced perfusion. The effects of vasoactive agents on the hepatosplanchnic circulation are variable, mostly anecdotal, and depend on baseline perfusion, time of drug administration, and use of concomitant medication. Microvascular blood flow disturbances are thought to play a pivotal role in the development of sepsisinduced multiorgan failure. Redistribution of intrahepatic blood flow in concert with a complex interplay between sinusoidal endothelial cells, liver macrophages, and passing leukocytes lead to a decreased perfusion and blood flow velocity in the liver sinusoids. Activation and dysfunction of the endothelial cell barrier with subsequent invasion of neutrophils and formation of microthrombi further enhance liver tissue ischemia and damage. Substances that regulate (micro)vascular tone, such as nitric oxide, endothelin-1, and carbon monoxide, are highly active during sepsis. Possible interactions between these mediators are not well understood, and their therapeutic manipulation produces equivocal or disappointing results. Whether and how standard resuscitation therapy influences the hepatic microvascular response to sepsis is unknown. Indirect evidence supports the concept that improving the microcirculation may prevent or ameliorate sepsis-induced organ failure. Anat Rec,

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The 21-Aminosteroid U74389G Enhances Hepatic Blood Flow and Preserves Sinusoidal Endothelial Cell Function and Structure in Endotoxin-Shocked Dogs

Spapen¹,

Zhang²,

Wisse³

et al. 1999

Journal of Surgical Research

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Goal-directed therapy with dopexamine, dobutamine, and volume expansion

Abstract: Increasing cardiac output and VO2 before and during infection was only protective when dopexamine was administered. Dobutamine infusion was associated with greater hepatic deterioration than that effect seen in either the control or volume groups.

Cited by 56 publications

References 19 publications

Dobutamine in Paediatric Population: A Systematic Review in Juvenile Animal Models

Dobutamine in Paediatric Population: A Systematic Review in Juvenile Animal Models

Liver Perfusion in Sepsis, Septic Shock, and Multiorgan Failure

The 21-Aminosteroid U74389G Enhances Hepatic Blood Flow and Preserves Sinusoidal Endothelial Cell Function and Structure in Endotoxin-Shocked Dogs

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