Dobutamine and gastric-to-arterial carbon dioxide gap in severe sepsis without shock

• Published in: Intensive care medicine 2002-03, Vol.28 (3), p.265-271
• Main Authors: LEBUFFE, Gilles, LEVY, Bruno, NEVIERE, Rémy, CHAGNON, Jean-L, PERRIGAULT, Pierre-F, DURANTEAU, Jacques, EDOUARD, Alain, TEBOUL, Jean-L, VALLET, Benoit
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; APACHE; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Carbon Dioxide - blood; Carbon Dioxide - metabolism; Cardiotonic Agents - therapeutic use; Digestive System - metabolism; Dobutamine - therapeutic use; Emergency and intensive care: infection, septic shock; Female; Hemodynamics - drug effects; Human bacterial diseases; Humans; Infectious diseases; Infusions, Intravenous; Intensive care medicine; Lactates - blood; Length of Stay; Male; Medical sciences; Middle Aged; Multiple Organ Failure - etiology; Multiple Organ Failure - mortality; Sepsis - classification; Sepsis - complications; Sepsis - drug therapy; Treatment Outcome
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-001-1198-x

To evaluate the effect of an early dobutamine infusion on gastrointestinal perfusion in patients with severe sepsis. Prospective, randomized, controlled, multicenter clinical study. Six medical and/or surgical intensive care units (ICU) of teaching hospitals. Forty-two patients with severe sepsis. Patients were divided into two groups according to gastric-to-arterial CO2 gap (DeltaCO2) [normal DeltaCO2 group ( n=17): DeltaCO2 < or = 8 mmHg; increased DeltaCO2 group ( n=25): DeltaCO2 > 8 mmHg]. Patients within each group were then randomized to receive either dobutamine (5 microg/kg per min) or saline for 72 h. SAPS II was similar in both groups [group 1: 44.0 (33.0-56.5); group 2: 48.5 (40.5-59.0), p=0.27]. At ICU admission, mean arterial pressure was lower in the high DeltaCO2 group [73.0 (67.0-79.5) mmHg, p=0.03] than in the normal DeltaCO2 group [84.0 (73.7-104.0) mmHg] while blood lactate [normal DeltaCO2 group: 1.6 (0.8-2.3); high DeltaCO2 group: 1.6 (1.1-1.9) mmol/l] was similar for the two groups. DeltaCO2 was significantly lower in the normal DeltaCO2 group [5.0 (2.0-6.0) mmHg)] than in the high DeltaCO2 group [11.0 (10.0-19.0) mmHg]. Dobutamine infusion did not significantly change hemodynamics, blood lactate concentration or tonometric parameters in any group within the first 72 h and had no particular beneficial effect in this population. An early infusion of dobutamine at a fixed dose of 5 microg/kg per min during the first 72 h of severe sepsis does not influence gastric DeltaCO2.