• D M Habib, J F Padbury, N G Anas, R M Perkin, and C Minegar.
• Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance.
• Crit. Care Med. 1992 May 1;20(5):601-8.

ObjectiveTo evaluate the pharmacokinetics and pharmacodynamics of dobutamine in critically ill children.DesignA prospective study of pediatric patients receiving continuous infusions of dobutamine in a stepwise format from 2.5 to 10.0 micrograms/kg/min.SettingA pediatric critical care unit.PatientsTwelve children ranging in age from 1 month to 17 yrs with primary medical conditions.MeasurementsPlasma dobutamine concentrations and hemodynamic responses were measured at each infusion rate at steady state. Dose response data were analyzed to determine the threshold or minimum plasma dobutamine concentration necessary for discernible hemodynamic effects.Main ResultsDobutamine plasma clearance rates ranged from 40 to 130 mL/kg/min. Each patient presented a linear increase in the plasma dobutamine concentration at each infusion rate (r2 = .97, p less than .001). Plasma clearance rate vs. actual dobutamine concentration did not vary. Cardiac output, BP, and heart rate increased 30%, 17%, and 7%, respectively, at maximal dose. The dobutamine concentration thresholds for changes in cardiac output, BP, and heart rate were 13 +/- 6, 23 +/- 14, and 65 +/- 30 ng/mL, respectively.ConclusionsThere was no effect of plasma dobutamine concentration or infusion rate on plasma clearance rate. For this group of patients, over the range of the intravenous doses studied, dobutamine pharmacokinetics followed a first-order kinetic model. Threshold values for dobutamine usually show increases in cardiac output before changes in heart rate. These data demonstrate that dobutamine is an effective inotropic agent in critically ill pediatric patients and has minimal chronotropic action.

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