Background
Methods
Patients
-
Systolic arterial pressure ≤ 90 mmHg or decreases of more than 50 mmHg in the last 3 h or mean arterial pressure ≤ 65 mmHg
-
Oliguria ≤ 0.5 mL/kg/h for more than 2 h
-
Blood lactate ≥ 2 mmol/L (or 22 mg/dL)
-
Central venous oxygen saturation ≤ 60%
-
Skin mottling
Recorded variables
Study design
Data analysis
Results
Patients
Clinical variable | All patients (n = 19) |
---|---|
Weight (kg) | 81 ± 19 |
Height (cm) | 166 ± 10 |
Age (years) | 71 ± 9 |
Apache II (points) | 25 ± 10 |
VT (mL) | 406 ± 71 |
RR (min−1) | 20 (18–25) |
FiO2 | 0.37 ± 0.08 |
PaO2/FiO2 | 257 ± 101 |
PEEP (cmH2O) | 6 (5–8) |
Pplat (cmH2O) | 19 ± 5 |
NE (µg kg−1 min−1) | 0.92 ± 0.93 |
DBT (µg kg−1 min−1) | 5.39 ± 4.9) |
WBC (× 103 dL−1) | 18.6 (11–23) |
CRP (mg dL−1) | 24 ± 11.5 |
Cr (mg dL−1) | 2.4 ± 1.2 |
Bil (mg dL−1) | 1.1 (0.4–3.4) |
Lactate (mg dL−1) | 48.3 ± 30 |
Haemodynamic variable | DBT (n = 17)a | NE (n = 29)a | VE/PLR (n = 24)a | All interventions (n = 70)a |
---|---|---|---|---|
Femoral dP/dtmax (mmHg s−1) | 1049 ± 347 | 1319 ± 371 | 1162 ± 336 | 1199 ± 365 |
HR (beats min−1) | 89 ± 14 | 92 ± 18 | 90 ± 15 | 90 (74–104) |
SAP (mmHg) | 117 ± 17 | 137 ± 25 | 123 ± 14 | 127 ± 21 |
MAP (mmHg) | 75 ± 7 | 84 ± 16 | 78 (75–84) | 78 (70–86) |
PP (mmHg) | 66 ± 17 | 80 ± 18 | 70 ± 11 | 73 ± 17 |
CVP (mmHg) | 9 ± 4 | 9 (8–12) | 11 ± 4 | 9 (8-12) |
GEDVi (mL m−2) | 749 ± 120 | 773 (684–878) | 773 ± 146 | 750 (671–846) |
CI (L min−1 m−2) | 2.7 ± 0.6 | 3.1 ± 1.2 | 3 (2.5–3.5) | 3 (2.2–3.4) |
SVI (mL m−2) | 31 ± 9 | 35 ± 14 | 32 (24–45) | 32 (25–44) |
CFI (min−1) | 3.9 ± 1.2 | 4.3 ± 1.6 | 4.4 ± 1.7 | 4.2 ± 1.6 |
LVEF (%) | 43 ± 11 | 57 (42–61) | 54 ± 17 | 50 ± 14 |
Ea (mmHg ml−1) | 2 ± 0.5 | 2 (1.3–2.4) | 1.9 (1.4–2.2) | 1.9 (1.4–2.3) |
TAC (ml mmHg−1) | 0.9 ± 0.3 | 0.8 (0.6–1.2) | 0.8 (0.8–1.1) | 0.8 (0.7–1.1) |
SVRi (dynes s cm−5 m−2) | 1774 (1657–2379) | 2241 ± 1078 | 1739 (1575–2172)b | 1775 (1627–2404)b |
Effects of dobutamine
Haemodynamic variable | DBT changes | NE changes | VE/PLR | |||
---|---|---|---|---|---|---|
Mean difference ± SD |
P
a
| Mean difference ± SD |
P
a
| Mean difference ± SD |
P
a
| |
Femoral dP/dtmax (mmHg s−1) | 201 ± 298 |
0.013
| 177 ± 136 |
< 0.001
| 59 ± 304 | 0.355 |
CFI (min−1) | 0.3 ± 0.4 |
0.013
| 0.1 ± 0.2 | 0.124b | 0.2 ± 0.4 |
0.042
|
LVEF (%) | 7 ± 5 |
< 0.001
| 5 ± 13 |
0.025
b
| − 1 ± 4 | 0.309b |
CI (L min−1 m−2) | 0.3 ± 0.5 |
0.031
| 0.1 ± 0.2 | 0.112 | 0.1 ± 0.4 | 0.153b |
SVI (mL m−2) | 0.7 ± 3.7 | 0.163b | 1.2 ± 3 |
0.040
| 1.9 ± 4.1 |
0.028
b
|
HR (beats min−1) | 4 ± 8 |
0.027
| 1 ± 3 | 0.079 | − 2 ± 5 |
0.019
b
|
SAP (mmHg) | 7 ± 15 | 0.065 | 18 ± 14 |
< 0.001
| 11 ± 22 |
0.027
|
MAP (mmHg) | 3 ± 7 | 0.089 | 9 ± 7 |
< 0.001
| 5 ± 14 | 0.092b |
PP (mmHg) | 13 ± 10 |
< 0.001
| 6 ± 12 |
< 0.001
b
| 6 ± 16 | 0.072 |
CVP (mmHg) | 0 ± 2 | 0.748 | 1 ± 2 | 0.099b | 3 ± 3 |
0.001
|
GEDVi (mL m−2) | 61 ± 244 | 0.535b | 3 ± 86 | 0.380b | − 17 ± 74 | 0.268 |
Ea (mmHg mL−1) | 0.05 ± 0.2 | 0.403 | 0.18 ± 0.2 |
< 0.001
b
| 0 ± 0.4 | 0.339b |
TAC (mL mmHg−1) | 0.01 ± 0.1 | 0.696 | 0.15 ± 0.1 |
0.001
| 0.03 ± 0.2 | 0.394b |
SVRi (dynes s cm−5 m−2) | 94 ± 157 |
0.025
| 109 ± 210 |
0.009
| 32 ± 272 | 0.574 |