Different dosages of dobutamine in septic shock patients : determining oxygen consumption with a metabolic monitor integrated in a ventilator

• Published in: Intensive care medicine Vol. 26; no. 12; pp. 1740 - 1746
• Main Authors: SCHAFFARTZIK, Walter, SANFT, Carsten, SCHAEFER, Jürgen Heiner, SPIES, Claudia
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.12.2000; Berlin Springer Nature B.V
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bias; Biological and medical sciences; Blood Gas Analysis; Calorimetry, Indirect - methods; Cardiotonic Agents - administration & dosage; Cardiotonic Agents - pharmacology; Dobutamine - administration & dosage; Dobutamine - pharmacology; Dose-Response Relationship, Drug; Drug Monitoring - methods; Emergency and intensive care: infection, septic shock; Hemodynamics - drug effects; Humans; Infusions, Intravenous; Intensive care medicine; Medical sciences; Metabolism; Middle Aged; Oxygen Consumption - drug effects; Parenteral nutrition; Prospective Studies; Respiration, Artificial - methods; Sepsis; Shock, Septic - drug therapy; Shock, Septic - metabolism; Shock, Septic - physiopathology; Ventilators; Shock; Human; Intensive care; Dobutamine; Cardiovascular disease; Oxygen consumption; Artificial ventilation; Infection; Assay; Sepsis syndrome; Bacteriosis; Calorimetry; Mechanical ventilation; Monitoring
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s001340000635

Oxygen consumption (VO2) obtained from respiratory gases by indirect calorimetry (VO2,IC) with a metabolic monitor integrated in a ventilator were to be compared to VO2 obtained by the Fick principle (VO2,Fick) in septic patients following an increase in oxygen delivery (DO2) induced by positive inotropic support. Prospective clinical study. University Hospital, Surgical Intensive Care Unit (ICU). Thirty patients suffering from sepsis. DO2 was increased by dobutamine infusion, starting with an initial dosage of 5 microg x kg x min, increased to a maximum of 10 microg x kg x min. Dobutamine infusion induced a dosage-related increase in DO2 (from 577 +/- 192 to 752 +/- 202 ml x min x m2, p < 0.01), which was associated with a statistically significant increase in VO2,IC (from 173 +/- 30 to 188 +/- 28 ml x min x m2, p < 0.01) and in VO2,Fick (from 140 +/- 25 to 156 +/- 24 ml x min x m2, p < 0.01). The comparison between VO2,IC and VO2,Fick revealed differences (bias and precision--33 +/- 32 ml x min x m2). With a metabolic monitor integrated in a ventilator it was possible to carry out continuous monitoring of calorimetric data under clinical conditions. In contrast to previous studies using indirect calorimetry, this study showed a moderate correlation between VO2 and DO2 in septic patients using either method. The clinical relevance of this finding requires further investigation. Different factors (e. g. injectant temperature, pulmonary VO2) produced substantial differences between VO2,IC and VO2,Fick as previously shown.