• Carolina Enrico, Vanina S Kanoore Edul, Alejandro Risso Vazquez, María C Pein, Ricardo A Pérez de la Hoz, Can Ince, and Arnaldo Dubin.
• Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.
• J Crit Care. 2012 Dec 1;27(6):630-8.

PurposeThe aim of this study was to characterize the cardiovascular responses to dobutamine and their predictors. Our hypotheses were that dobutamine mainly produces tachycardia and vasodilation and fails to improve the microcirculation of patients with septic shock.Materials And MethodsSystemic hemodynamics and sublingual microcirculation were evaluated with dobutamine (0, 2.5, 5.0, and 10.0 μg kg(-1) min(-1)) in 23 patients with septic shock.ResultsDobutamine increased heart rate, cardiac index, and stroke volume index (SVI). Mean blood pressure was unchanged, and systemic vascular resistance decreased. Individual responses were heterogeneous. Stroke volume index increased in 52% of the patients. These patients showed lower changes in mean blood pressure (3 ± 16 mm Hg vs -10 ± 6 mm Hg, P < .05) and higher increases in cardiac index (1.47 ± 0.93 L m(-1) m(-2) vs 0.20 ± 0.5 L m(-1) m(-2)) than did nonresponders. Changes in SVI significantly correlated with echocardiographic left ventricular ejection fraction (r = 0.55). In the whole group, perfused capillary density remained unchanged (14.0 ± 4.3 mm/mm(2) vs 14.8 ± 3.7 mm/mm(2)), but improved if basal values were 12 mm/mm(2) or less (9.1 ± 4.3 mm/mm(2) vs 12.5 ± 4.8 mm/mm(2)).ConclusionsDobutamine produced variable hemodynamic effects. Systolic dysfunction was the only variable associated with increases in SVI. Finally, dobutamine only improved sublingual microcirculation when severe alterations were found at baseline.Copyright © 2012 Elsevier Inc. All rights reserved.

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