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Conventional hemodynamic resuscitation may fail to optimize tissue perfusion: an observational study on the effects of dobutamine, enoximone, and norepinephrine in patients with acute myocardial infarction complicated by cardiogenic shock.
- Source :
-
PloS one [PLoS One] 2014 Aug 01; Vol. 9 (8), pp. e103978. Date of Electronic Publication: 2014 Aug 01 (Print Publication: 2014). - Publication Year :
- 2014
-
Abstract
- Aim: To investigate the effects of inotropic agents on parameters of tissue perfusion in patients with cardiogenic shock.<br />Methods and Results: Thirty patients with cardiogenic shock were included. Patients received dobutamine, enoximone, or norepinephrine. We performed hemodynamic measurements at baseline and after titration of the inotropic agent until cardiac index (CI) ≥ 2.5 L.min-1.m(-2) or mixed-venous oxygen saturation (SvO2) ≥ 70% (dobutamine or enoximone), and mean arterial pressure (MAP) ≥ 70 mmHg (norepinephrine). As parameters of tissue perfusion, we measured central-peripheral temperature gradient (delta-T) and sublingual perfused capillary density (PCD). All patients reached predefined therapeutic targets. The inotropes did not significantly change delta-T. Dobutamine did not change PCD. Enoximone increased PCD (9.1 [8.9-10.2] vs. 11.4 [8.4-13.9] mm.mm(-2); p<0.05), and norepinephrine tended to decrease PCD (9.8 [8.5-11.9] vs. 8.8 [8.2-9.6] mm.mm-2, p = 0.08). Fifteen patients (50%) died within 30 days after admission. Patients who had low final PCD (≤ 10.3 mm.mm-2; 64%) were more likely to die than patients who had preserved PCD (>10.3 mm.mm(-2); mortality 72% vs. 17%, p = 0.003).<br />Conclusion: This study demonstrates the effects of commonly used inotropic agents on parameters of tissue perfusion in patients with cardiogenic shock. Despite hemodynamic optimization, tissue perfusion was not sufficiently restored in most patients. In these patients, mortality was high. Interventions directed at improving microcirculation may eventually help bridging the gap between improved hemodynamics and dismal patient outcome in cardiogenic shock.
- Subjects :
- Aged
Aged, 80 and over
Capillaries drug effects
Capillaries physiopathology
Dobutamine administration & dosage
Enoximone administration & dosage
Female
Humans
Male
Middle Aged
Myocardial Infarction mortality
Myocardial Infarction physiopathology
Norepinephrine administration & dosage
Perfusion
Pulmonary Circulation drug effects
Shock, Cardiogenic mortality
Shock, Cardiogenic physiopathology
Treatment Outcome
Dobutamine pharmacology
Enoximone pharmacology
Hemodynamics drug effects
Microcirculation drug effects
Myocardial Infarction complications
Norepinephrine pharmacology
Resuscitation
Shock, Cardiogenic complications
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 9
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 25084171
- Full Text :
- https://doi.org/10.1371/journal.pone.0103978