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Effects of dobutamine on systemic, regional and microcirculatory perfusion parameters in septic shock: a randomized, placebo-controlled, double-blind, crossover study

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Abstract

Purpose

The role of dobutamine during septic shock resuscitation is still controversial since most clinical studies have been uncontrolled and no physiological study has unequivocally demonstrated a beneficial effect on tissue perfusion. Our objective was to determine the potential benefits of dobutamine on hemodynamic, metabolic, peripheral, hepatosplanchnic and microcirculatory perfusion parameters during early septic shock resuscitation.

Methods

We designed a randomized, controlled, double-blind, crossover study comparing the effects of 2.5-h infusion of dobutamine (5 mcg/kg/min fixed-dose) or placebo in 20 septic shock patients with cardiac index ≥2.5 l/min/m2 and hyperlactatemia. Primary outcome was sublingual perfused microvascular density.

Results

Despite an increasing cardiac index, heart rate and left ventricular ejection fraction, dobutamine had no effect on sublingual perfused vessel density [9.0 (7.9–10.1) vs. 9.1 n/mm (7.9–9.9); p = 0.24] or microvascular flow index [2.1 (1.8–2.5) vs. 2.1 (1.9–2.5); p = 0.73] compared to placebo. No differences between dobutamine and placebo were found for the lactate levels, mixed venous-arterial pCO2 gradient, thenar muscle oxygen saturation, capillary refill time or gastric-to-arterial pCO2 gradient. The indocyanine green plasma disappearance rate [14.4 (9.5–25.6) vs. 18.8 %/min (11.7–24.6); p = 0.03] and the recovery slope of thenar muscle oxygen saturation after a vascular occlusion test [2.1 (1.1–3.1) vs. 2.5 %/s (1.2–3.4); p = 0.01] were worse with dobutamine compared to placebo.

Conclusions

Dobutamine failed to improve sublingual microcirculatory, metabolic, hepatosplanchnic or peripheral perfusion parameters despite inducing a significant increase in systemic hemodynamic variables in septic shock patients without low cardiac output but with persistent hypoperfusion.

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Acknowledgments

We thank research nurse Leyla Alegría for her valuable support during the execution of the study. We acknowledge the role of Dr. Luis Villarroel in giving statistical advice for this article. This study was funded by a grant from FONDECYT Chile, Project 1100610.

Conflicts of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, 8320000, Santiago, Chile

    Glenn Hernandez, Alejandro Bruhn, Tomas Regueira, Eduardo Kattan, Andrea Fuentealba, Jorge Florez, Ricardo Castro, Andres Aquevedo & Ronald Pairumani

  2. Department of Translational Physiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Glenn Hernandez & Can Ince

  3. Unidad de Pacientes Críticos, Hospital Clínico Universidad de Chile, Santos Dumont 999 Independencia, Santiago, Chile

    Cecilia Luengo

  4. Departamento de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile

    Paul McNab

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  1. Glenn Hernandez
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Corresponding author

Correspondence to Glenn Hernandez.

Additional information

ClinicalTrials.gov Identifier: NCT01271153.

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Hernandez, G., Bruhn, A., Luengo, C. et al. Effects of dobutamine on systemic, regional and microcirculatory perfusion parameters in septic shock: a randomized, placebo-controlled, double-blind, crossover study. Intensive Care Med 39, 1435–1443 (2013). https://doi.org/10.1007/s00134-013-2982-0

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