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Emergency Medicine Clinics of North... Feb 2017Vasopressor and inotropes are beneficial in shock states. Norepinephrine is considered the first-line vasopressor for patients with sepsis-associated hypotension.... (Review)
Review
Vasopressor and inotropes are beneficial in shock states. Norepinephrine is considered the first-line vasopressor for patients with sepsis-associated hypotension. Dobutamine is considered the first-line inotrope in sepsis, and should be considered for patients with evidence of myocardial dysfunction or ongoing signs of hypoperfusion. Vasopressor and inotrope therapy has complex effects that are often difficult to predict; emergency providers should consider the physiology and clinical trial data. It is essential to continually reevaluate the patient to determine if the selected treatment is having the intended result.
Topics: Cardiotonic Agents; Dobutamine; Emergency Service, Hospital; Heart; Humans; Norepinephrine; Sepsis; Shock, Septic; Vasoconstrictor Agents
PubMed: 27908339
DOI: 10.1016/j.emc.2016.09.005 -
Journal of Nuclear Cardiology :... Feb 2021
Topics: Dipyridamole; Dobutamine; Humans; Positron-Emission Tomography; Rubidium Radioisotopes; Tomography, X-Ray Computed; Vasodilator Agents
PubMed: 32968970
DOI: 10.1007/s12350-020-02309-8 -
Journal of Cardiothoracic and Vascular... Mar 2023This study was designed to compare the effects of levosimendan and dobutamine on hemodynamics and clinical efficacy in patients with severe septic cardiomyopathy (left... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
This study was designed to compare the effects of levosimendan and dobutamine on hemodynamics and clinical efficacy in patients with severe septic cardiomyopathy (left ventricular ejection fraction [LVEF] ≤35%).
DESIGN
A prospective, single-blind, randomized controlled study.
SETTING
In Baoding, China.
PARTICIPANTS
Thirty patients with severe septic cardiomyopathy treated in the authors' hospital's Department of Critical Medicine from September 2018 to September 2021 were enrolled in this study.
INTERVENTIONS
These patients were divided randomly into the levosimendan group and dobutamine group. The LVEF, cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index, heart rate, norepinephrine dose, and lactate at the time of enrollment and the 24th hour were compared, along with myocardial injury markers on the third day, C-reactive protein, mechanical ventilation time, length of intensive care unit (ICU) stay, cost, and 28-day mortality. The primary outcome was 28-day mortality.
MEASUREMENTS AND MAIN RESULTS
At the 24th hour after treatment, CI, LVEF, SVI, and fluid volume were found to be higher in the levosimendan group than in the dobutamine group, whereas the dose of norepinephrine was lower in the former rather than the latter group. On the third day of treatment, cardiac troponin I in the levosimendan group was lower than that in the dobutamine group. Although the differences in 28-day mortality, ICU stay, and ICU treatment cost between the groups were not statistically significant, the ventilator application time of the levosimendan group was significantly shorter than that of the dobutamine group.
CONCLUSIONS
Compared with dobutamine, levosimendan was more effective at improving cardiac function, reducing myocardial injury, and reducing mechanical ventilation time in patients with severe septic cardiomyopathy.
Topics: Humans; Simendan; Dobutamine; Stroke Volume; Prospective Studies; Single-Blind Method; Hydrazones; Pyridazines; Shock, Septic; Ventricular Function, Left; Sepsis; Norepinephrine; Cardiomyopathies; Cardiotonic Agents
PubMed: 36473763
DOI: 10.1053/j.jvca.2022.10.032 -
Pediatric Cardiology Jan 2016Since its discovery in 1975 dobutamine has been used off-label for treating hemodynamic insufficiency in newborns and children. We present a structured literature review... (Review)
Review
Since its discovery in 1975 dobutamine has been used off-label for treating hemodynamic insufficiency in newborns and children. We present a structured literature review of pharmacokinetic and pharmacodynamic data for dobutamine in the pediatric population. Structured searches were conducted to identify relevant articles according to pre-defined inclusion criteria. Where possible, results for the pharmacodynamic and pharmacokinetic effect of dobutamine were reported as pooled data. Forty-six papers met the inclusion criteria. With regard to pharmacodynamic data a number of studies reported significant increases in a number of clinical parameters such as heart rate, blood pressure, cardiac output across a wide range of pediatric populations. With regard to pharmacokinetic data studies reported that the infusion rate was positively correlated to plasma dobutamine concentration. There was great variability with regard to dobutamine clearance between individuals and as to whether it followed first- or zero-order elimination kinetics. While the pharmacodynamic effects of dobutamine appear to reflect the pharmacological profile of the drug, the pharmacokinetic data are difficult to interpret due to inhomogeneity between study populations ages, comorbidities, dobutamine dosages and methodologies. High-quality prospective pharmacokinetic and pharmacodynamic data especially in newborns are urgently required prior to a large randomized study.
Topics: Blood Pressure; Cardiac Output; Child; Dobutamine; Dose-Response Relationship, Drug; Heart Rate; Humans; Hypotension; Infant; Infant, Newborn; Sympathomimetics
PubMed: 26346024
DOI: 10.1007/s00246-015-1263-9 -
BMC Cardiovascular Disorders May 2023Sepsis is the leading cause of death in intensive care units. Sepsis-induced myocardial dysfunction, one of the most serious complications of sepsis, is associated with...
BACKGROUND
Sepsis is the leading cause of death in intensive care units. Sepsis-induced myocardial dysfunction, one of the most serious complications of sepsis, is associated with higher mortality rates. As the pathogenesis of sepsis-induced cardiomyopathy has not been fully elucidated, there is no specific therapeutic approach. Stress granules (SG) are cytoplasmic membrane-less compartments that form in response to cellular stress and play important roles in various cell signaling pathways. The role of SG in sepsis-induced myocardial dysfunction has not been determined. Therefore, this study aimed to determine the effects of SG activation in septic cardiomyocytes (CMs).
METHODS
Neonatal CMs were treated with lipopolysaccharide (LPS). SG activation was visualized by immunofluorescence staining to detect the co-localization of GTPase-activating protein SH3 domain binding protein 1 (G3BP1) and T cell-restricted intracellular antigen 1 (TIA-1). Eukaryotic translation initiation factor alpha (eIF2α) phosphorylation, an indicator of SG formation, was assessed by western blotting. Tumor necrosis factor alpha (TNF-α) production was assessed by PCR and enzyme-linked immunosorbent assays. CMs function was evaluated by intracellular cyclic adenosine monophosphate (cAMP) levels in response to dobutamine. Pharmacological inhibition (ISRIB), a G3BP1 CRISPR activation plasmid, and a G3BP1 KO plasmid were employed to modulate SG activation. The fluorescence intensity of JC-1 was used to evaluate mitochondrial membrane potential.
RESULTS
LPS challenge in CMs induced SG activation and resulted in eIF2α phosphorylation, increased TNF-α production, and decreased intracellular cAMP in response to dobutamine. The pharmacological inhibition of SG (ISRIB) increased TNF-α expression and decreased intracellular cAMP levels in CMs treated with LPS. The overexpression of G3BP1 increased SG activation, attenuated the LPS-induced increase in TNF-α expression, and improved CMs contractility (as evidenced by increased intracellular cAMP). Furthermore, SG prevented LPS-induced mitochondrial membrane potential dissipation in CMs.
CONCLUSION
SG formation plays a protective role in CMs function in sepsis and is a candidate therapeutic target.
Topics: Infant, Newborn; Humans; DNA Helicases; Dobutamine; Lipopolysaccharides; Myocytes, Cardiac; Poly-ADP-Ribose Binding Proteins; RNA Helicases; RNA Recognition Motif Proteins; Stress Granules; Tumor Necrosis Factor-alpha
PubMed: 37312024
DOI: 10.1186/s12872-023-03281-0 -
Expert Review of Cardiovascular Therapy Mar 2017Vasodilator and dobutamine are the main pharmacological agents used in current stress cardiovascular magnetic resonance (CMR). Exercise stress has well-established... (Review)
Review
Vasodilator and dobutamine are the main pharmacological agents used in current stress cardiovascular magnetic resonance (CMR). Exercise stress has well-established advantages and it is commonly used in other stress imaging, but the technical considerations have limited its use in stress CMR. In this review, we will describe the diagnostic performance, prognostic value, strengths and challenges of current stress CMR techniques. We will also discuss future perspectives of exercise stress CMR. Areas covered: Despite notable mechanistic differences, vasodilator and dobutamine stress CMR offer similar diagnostic and prognostic value in coronary artery disease. Combined perfusion and wall motion assessment has been explored with dobutamine stress CMR: diagnostic sensitivity improved at the expense of reduced specificity. However, a combined assessment may provide additional prognostic value in selected patients. There is emerging interest and promising data in exercise stress CMR because of the availability of CMR-compatible stress equipment and development of novel real-time sequences that allow imaging during exercise with adequate spatiotemporal resolution. Expert commentary: Exercise stress CMR is able to assess wall motion abnormalities, perfusion defects, exercise capacity and viability in a single examination. This holds important clinical potential in a variety of cardiovascular conditions.
Topics: Coronary Artery Disease; Dobutamine; Exercise Test; Humans; Magnetic Resonance Imaging; Sensitivity and Specificity; Vasodilator Agents
PubMed: 28256176
DOI: 10.1080/14779072.2017.1296356 -
Neonatal Network : NN Jan 2017Hypotension is a common problem in neonates with complex underlying pathophysiology. Although treatment of low blood pressure is common, clinicians must use all...
Hypotension is a common problem in neonates with complex underlying pathophysiology. Although treatment of low blood pressure is common, clinicians must use all available information to target neonates with compromised perfusion. Pharmacotherapy should be tailored to the specific physiologic perturbations of the individual neonate. Dopamine is the most commonly utilized agent and may be the most appropriate agent for septic shock with low diastolic blood pressure. However, alternative therapies should be considered for other etiologies of hypotension, including milrinone and vasopressin for persistent pulmonary hypertension of the newborn and dobutamine for patent ductus arteriosus. Additional studies are required to refine the approach to neonatal hypotension and document the long-term outcomes of treated neonates.
Topics: Blood Pressure; Cardiotonic Agents; Dobutamine; Dopamine; Ductus Arteriosus, Patent; Humans; Hypotension; Infant, Newborn; Long Term Adverse Effects; Milrinone; Shock, Septic
PubMed: 28137353
DOI: 10.1891/0730-0832.36.1.40 -
The Journal of Surgical Research Mar 2019Gastrointestinal blood flow may be compromised during and after vasopressor support. Endothelin expression may lead to microcirculatory dysfunction. The aim of this... (Comparative Study)
Comparative Study
BACKGROUND
Gastrointestinal blood flow may be compromised during and after vasopressor support. Endothelin expression may lead to microcirculatory dysfunction. The aim of this study was to analyze the effect of vasopressin and dobutamine after mesenteric ischemia on the gastrointestinal mucosal microcirculation, endothelin expression, and morphologic injury.
MATERIALS AND METHODS
Pigs were studied in four groups (six pigs in each group): 1, sham; 2-4 ischemia (1 h superior mesenteric artery occlusion with 30 min reperfusion and 30 min of vehicle [2], dobutamine [3], or vasopressin [4] administration, followed by 30-min break and thiopental-induced hypotension [3, 4]). Blood flow of the gastric, jejunal, and rectosigmoidal mucosa was measured. At the end of the experiment, the mucosal expression of endothelin-1 (ET-1) and its receptor subtypes A (ET) and B were determined by polymerase chain reaction. Mucosal injury, apoptotic cell death, and leukocytic infiltration were determined by histology and immunohistochemical analysis of cleaved caspase-3 and myeloperoxidase.
RESULTS
Mesenteric ischemia increased jejunal mucosal ET-1 gene expression, arterial ET-1, intestinal fatty acid binding protein, and jejunal mucosal injury compared with sham. Dobutamine increased arteriovenous shunting at the cost of the jejunal mucosal blood perfusion. This was associated with an increased expression of ET-1 and ET and mucosal leukocytic infiltration. In contrast, vasopressin increased postischemic capillary density and tissue blood flow. This was associated with a lower ET-1 gene expression. Vasopressin did not induce jejunal mucosal leukocytic infiltration.
CONCLUSIONS
Vasopressin reduces mesenteric ischemia-associated alterations of the microcirculation and tissue integrity, whereas dobutamine does not.
Topics: Adrenergic beta-1 Receptor Agonists; Animals; Dobutamine; Drug Evaluation, Preclinical; Endothelin-1; Fatty Acid-Binding Proteins; Intestinal Mucosa; Mesenteric Ischemia; Microcirculation; Swine; Vasoconstrictor Agents; Vasopressins
PubMed: 30691823
DOI: 10.1016/j.jss.2018.10.028 -
Journal of Emergency Nursing Mar 2015
Topics: Dobutamine; Dopamine; Epinephrine; Fluid Therapy; Humans; Infant; Male; Norepinephrine; Phosphodiesterase Inhibitors; Shock, Septic; Vasoconstrictor Agents
PubMed: 25769996
DOI: 10.1016/j.jen.2014.12.015 -
Veterinary Journal (London, England :... Apr 2020Sympathomimetic drugs mimic the physiological action of the sympathetic nervous system through interaction with adrenergic receptors. These drugs are commonly used to... (Review)
Review
Sympathomimetic drugs mimic the physiological action of the sympathetic nervous system through interaction with adrenergic receptors. These drugs are commonly used to provide cardiovascular support in many veterinary species. Despite their common use, the literature evaluating their effectiveness can be somewhat limited depending on the species. This review details the mechanism of action of various sympathomimetic drugs and summarizes the literature that is available describing the efficacy of these drugs and their use in anesthetized veterinary species.
Topics: Anesthesia; Animals; Cardiovascular Physiological Phenomena; Cats; Dobutamine; Dogs; Dopamine; Horses; Norepinephrine; Sympathetic Nervous System; Sympathomimetics
PubMed: 32564865
DOI: 10.1016/j.tvjl.2020.105455