TREATING SEPSIS

Dobutamine

Dobutamine is a potent beta-1 agonist, with predominant effects in the heart where it increases myocardial contractility and thus stroke volume and cardiac output. Dobutamine is associated with much less increase in heart rate than dopamine. Dobutamine has a mild vasodilatory effect (inodilator), reducing mean arterial pressure: thus the heart pumps “downhill”, which makes this agent very effective in cardiogenic shock. Dobutamine differs from isoproteranol in that it has less beta-2 activity (bronchodilation) and has less effect on heart rate (isoproteranol is predominantly used as a stop-gap in patients requiring a pacemaker due to it’s chronotrophic effect). In sepsis, dobutamine, although a vasodilator, increases oxygen delivery and consumption. Dobutamine appears particularly effective at splanchnic resuscitation, increasing pHi (gastric mucosal pH) and improving mucosal perfusion in comparison with dopamine (1). It appears that dobutamine is a useful second line agent to add in septic shock, to improve cardiac performance and to improve splanchnic perfusion. The combination with nor-epinephrine would appear appropriate.

References

(1)   Neviere R, Mathieu D, Chagnon JL, Lebleu N, Wattel F. The contrasting effects of dobutamine and dopamine on gastric mucosal perfusion in septic patients. Am J Respir Crit Care Med 1996; 154(6 Pt 1):1684-1688.

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