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

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 ino...

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Bibliographic Details
Published in:Intensive care medicine 2000-12, Vol.26 (12), p.1740-1746
Main Authors: SCHAFFARTZIK, Walter, SANFT, Carsten, SCHAEFER, Jürgen Heiner, SPIES, Claudia
Format: Article
Language:English
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
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Summary: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.
ISSN:0342-4642
1432-1238
DOI:10.1007/s001340000635