Abstract:
OBJECTIVES:To explore the effects of dobutamine and norepinephrine on the global cardiovascular response and on the relationship between oxygen uptake (VO2) and oxygen delivery (DO2) during an acute reduction in blood flow associated with tamponade. DESIGN:Prospective, randomized, controlled acute intervention study. SETTING:University intensive care unit (ICU) laboratory. SUBJECTS:Twenty healthy, anesthetized mongrel dogs, weighing 19 to 28 kg. INTERVENTIONS:Six dogs served as control, seven dogs were given 10 micrograms/kg/min of dobutamine and another seven dogs were given 1 microgram/kg/min of norepinephrine. Data were collected at graded incremental levels of intrapericardial pressure. MEASUREMENTS AND MAIN RESULTS:VO2 was derived from expired gas analysis and DO2 was calculated from the product of thermodilution cardiac index and arterial oxygen content. In each animal, two catheters were inserted into the pericardium to induce tamponade by saline infusion and to measure the intrapericardial pressure. The critical Do2 value, below which VO2 decreased, was found at 9.4 +/- 1.3 mL/kg/min in the control animals. When DO2 decreased to below this critical value, lactic acidosis developed. Dobutamine and norepinephrine, at the dose that was administered, significantly increased cardiac index and DO2. Critical DO2 was slightly higher in the treated than in the control animals (12.1 +/- 1.6 mL/kg/min in dobutamine and 13.2 +/- 0.9 mL/kg/min in norepinephrine, NS). VO2 at critical DO2 was significantly higher in the treated groups than in the control group (7.7 +/- 1.1 mL/kg/min in the dobutamine group and 7.9 +/- 0.9 mL/kg/min in the norepinephrine group vs. 5.4 +/- 0.4 mL/kg/min in control, both p < .01). There was no significant difference in the critical oxygen extraction ratio and the slope of the supply-dependent line between the three groups. In dobutamine-treated animals, cardiac index, DO2, and VO2 were better maintained for any intrapericardial pressure than in the other groups. Critical intrapericardial pressure, at which VO2 started to decrease, was significantly higher in the dobutamine-treated group than in the control group (13.8 +/- 2.3 vs. 9.3 +/- 1.2 mm Hg, p < .05). At critical DO2, the mean blood lactate concentration was also lower in the dobutamine-treated animals than in the other animals (2.1 +/- 0.3 vs. 4.1 +/- 0.7 mmol/L in control and 3.8 +/- 0.4 mmol/L in the norepinephrine group, both p < .05). CONCLUSIONS:During low-flow states associated with tamponade, both dobutamine and norepinephrine at the dose used increased cardiac index, DO2, and VO2, but dobutamine delayed the onset of tissue hypoxia by further increasing blood flow and oxygen availability. In the conditions of the present study, neither agent significantly influenced the oxygen extraction capabilities of the body.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Zhang H,Spapen H,Vincent JLdoi
10.1097/00003246-199402000-00022subject
Has Abstractpub_date
1994-02-01 00:00:00pages
299-305issue
2eissn
0090-3493issn
1530-0293journal_volume
22pub_type
杂志文章abstract:OBJECTIVE:Anecdotal reports suggest that propofol (Diprivan) may stimulate mucus hypersecretion in patients without pulmonary disease. The purpose of this study was to evaluate the effect of methohexital or propofol anesthesia on the physical and transport properties of airway mucus in spontaneously breathing dogs. DE...
journal_title:Critical care medicine
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doi:10.1097/00003246-200105000-00035
更新日期:2001-05-01 00:00:00
abstract:OBJECTIVES:Palliative care is now recognized as an essential component of comprehensive care in serious illness that interferes with quality of life. We explored utilization of palliative care in spontaneous intracerebral hemorrhage at a population level using a large national database. DESIGN:Population based cross-s...
journal_title:Critical care medicine
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doi:10.1097/CCM.0000000000001391
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVES:We previously reported gene expression-based endotypes of pediatric septic shock, endotypes A and B, and that corticosteroid exposure was independently associated with increased mortality among pediatric endotype A patients. The Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial tested th...
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doi:10.1097/CCM.0000000000004709
更新日期:2021-01-01 00:00:00
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doi:10.1097/00003246-200009000-00038
更新日期:2000-09-01 00:00:00
abstract:OBJECTIVES:Swallowing disorders may be associated with adverse clinical outcomes in patients following invasive mechanical ventilation. We investigated the incidence of dysphagia, its time course, and association with clinically relevant outcomes in extubated critically ill patients. DESIGN:Prospective observational t...
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doi:10.1097/CCM.0000000000002765
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abstract:OBJECTIVES:To assess the impact of the percentage of fluid infused as Lactated Ringer (%LR) during the first 2 days of ICU admission in hospital mortality and occurrence of acute kidney injury. DESIGN:Retrospective cohort. SETTING:Analysis of a large public database (Multiparameter Intelligent Monitoring in Intensive...
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doi:10.1097/CCM.0000000000001948
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the effects of sympathetic and parasympathetic nervous system activity on the heart rate and other hemodynamic variables in acute emergency patients with mild to moderately severe trauma. DESIGN:Clinical study. SETTING:Level 1 university-run trauma service. PATIENTS:Fourteen trauma patients stu...
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doi:10.1097/01.ccm.0000127776.78490.e4
更新日期:2004-06-01 00:00:00
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pub_type: 杂志文章,评审
doi:10.1097/CCM.0000000000002691
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:Supplementation with tetrahydrobiopterin, a nitric oxide synthase cofactor, may reduce microvascular endothelial dysfunction in severe sepsis. We studied whether tetrahydrobiopterin administration exerts beneficial effects in an ovine septic shock model. DESIGN:Randomized animal study. SETTING:University ho...
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更新日期:2012-10-01 00:00:00
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doi:10.1097/00003246-200205000-00025
更新日期:2002-05-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000416
更新日期:2014-09-01 00:00:00
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pub_type: 杂志文章
doi:10.1097/00003246-198507000-00012
更新日期:1985-07-01 00:00:00
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journal_title:Critical care medicine
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doi:10.1097/00003246-199805000-00025
更新日期:1998-05-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198701000-00004
更新日期:1987-01-01 00:00:00
abstract::Intravenous dobutamine was used in ten patients requiring aggressive therapy for massive pulmonary embolism with circulatory failure. Except in one patient who rapidly died, a 30-min dobutamine infusion (8.3 +/- 2.7 micrograms/kg . min) increased both cardiac index (from 1.7 +/- 0.4 to 2.3 +/- 0.6 L/min . m2, p less t...
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更新日期:1985-12-01 00:00:00
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pub_type: 杂志文章
doi:10.1097/00003246-198409000-00022
更新日期:1984-09-01 00:00:00
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doi:10.1097/CCM.0b013e318168e4a8
更新日期:2008-04-01 00:00:00
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journal_title:Critical care medicine
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doi:10.1097/00003246-198308000-00006
更新日期:1983-08-01 00:00:00
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更新日期:2009-03-01 00:00:00
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更新日期:2006-12-01 00:00:00
abstract::The focus on improving education in critical care medicine must begin early in medical school training and further be promoted during residency if there is to be an increase in intensivists in the hospital workforce. This is "critical" to healthcare reform movements that are endorsing full-time critical care coverage ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000252917.25301.18
更新日期:2007-02-01 00:00:00
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doi:10.1097/00003246-200009001-00013
更新日期:2000-09-01 00:00:00
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journal_title:Critical care medicine
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doi:10.1097/CCM.0b013e3181ef455b
更新日期:2010-10-01 00:00:00
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journal_title:Critical care medicine
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doi:10.1097/CCM.0000000000004123
更新日期:2020-03-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200211000-00015
更新日期:2002-11-01 00:00:00
abstract:BACKGROUND AND METHODS:Twelve adult male albino rabbits were assigned alternately to normotensive and hypotensive groups to assess the effect of hypovolemic shock on spontaneous correction of dilutional coagulopathy. All animals underwent dilutional exchange transfusion with 200 mL of rabbit RBCs and 5% human albumin. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199102000-00022
更新日期:1991-02-01 00:00:00
abstract:OBJECTIVE:Cytomegalovirus reactivation may complicate critical illness in latent carriers of the virus, even in patients who were previously immunocompetent. Patients with acute respiratory distress syndrome are considered to be prone for reactivation. Prophylactic antiviral therapy in immunocompetent cytomegalovirus s...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000712
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVE:The Acute Respiratory Distress Syndrome Network protocol recommends limiting tidal volume and plateau pressure; it also recommends increasing respiratory rate to prevent hypercapnia. We tested a strategy that combines the low tidal volume with lower respiratory rates and minimally invasive CO2 removal. SUBJE...
journal_title:Critical care medicine
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doi:10.1097/CCM.0000000000000312
更新日期:2014-06-01 00:00:00