Hemodynamic effects and tolerance of dobutamine for myocardial dysfunction during septic shock: An observational multicenter prospective echocardiographic study

Keyvan Razazi; Vincent Labbé; Laurent Laine; Alexandre Bedet; Guillaume Carteaux; Nicolas de Prost; Florence Boissier; Francois Bagate; Armand Mekontso Dessap

doi:10.3389/fcvm.2022.951016

Hemodynamic effects and tolerance of dobutamine for myocardial dysfunction during septic shock: An observational multicenter prospective echocardiographic study

Front Cardiovasc Med. 2022 Sep 9:9:951016. doi: 10.3389/fcvm.2022.951016. eCollection 2022.

Authors

Keyvan Razazi^{1

2

3}, Vincent Labbé⁴, Laurent Laine⁵, Alexandre Bedet^{1

2

3}, Guillaume Carteaux^{1

2

3}, Nicolas de Prost^{1

2

3}, Florence Boissier^{1

6}, Francois Bagate^{1

2

3}, Armand Mekontso Dessap^{1

2

3}

Affiliations

¹ AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, Créteil, France.
² INSERM, Institut Mondor de Recherche Biomedicale (IMRB), Univ Paris Est Créteil, Créteil, France.
³ Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomedicale (IMRB), GRC CARMAS, Université Paris Est Créteil, Créteil, France.
⁴ Département Médico-Universitaire APPROCHES, AP-HP, Hôpital Tenon, Service de Médecine Intensive Réanimation, Sorbonne Université, Paris, France.
⁵ Hôpital Delafontaine, Service de Réanimation, Saint-Denis, France.
⁶ CHU de Poitiers, Service de Médecine Intensive Réanimation, Poitiers, France.

Abstract

Background: The role of dobutamine during septic shock resuscitation is still controversial.

Methods: The aim of this prospective multicentre study was to comprehensively characterize the hemodynamic response of septic shock patients with systolic myocardial dysfunction to incremental doses of dobutamine (0, 5, 10, and 15 μg/kg/min).

Results: Thirty two patients were included in three centers. Dobutamine significantly increased contractility indices of both ventricles [crude and afterload-adjusted left ventricular (LV) ejection fraction, global LV longitudinal peak systolic strain, tissue Doppler peak systolic wave at mitral and tricuspid lateral annulus, and tricuspid annular plane excursion) as well as global function indices (stroke volume and cardiac index) and diastolic function (increased e' and decreased E/e' ratio at lateral mitral annulus). Dobutamine also induced a significant decrease in arterial pressure and cardiac afterload indices (effective arterial elastance, systemic vascular resistance and diastolic shock index). Oxygen transport, oxygen consumption and carbon dioxide production all increased with dobutamine, without change in the respiratory quotient or lactate. Dobutamine was discontinued for poor tolerance in a majority of patients (n = 21, 66%) at any dose and half of patients (n = 15, 47%) at low-dose (5 μg/kg/min). Poor tolerance to low-dose dobutamine was more frequent in case of acidosis, was associated with lower vasopressor-free days and survival at day-14.

Conclusion: In patients with septic myocardial dysfunction, dobutamine induced an overall improvement of echocardiographic parameters of diastolic and systolic function, but was poorly tolerated in nearly two thirds of patients, with worsening vasoplegia. Patients with severe acidosis seemed to have a worse response to dobutamine.

Keywords: dobutamine; echocardiography; mortality; myocardial depression; septic shock.