Dopexamine Test in septic shock with hyperlactatemia

作者：Mayeur N^*; Vallee F; De Soyres O; Mebazaa A; Salem R; Fourcade O; Minville V; Genestal M

来源：Annales Francaises d Anesthesie et de Reanimation, 2010, 29(11): 759-764.

DOI：10.1016/j.annfar.2010.07.012

• Dopexamine
• Septic shock
• beta 2-adrenergic agonist
• Norepinephrine
• Lactate

Objective. - To evaluate the 6 hours haemodynamic effects of dopexamine (DPX) infusion in septic shock patients with persistent hyperlactatemia treated with high dose of norepinephrine (NE).
Study design. - Preliminary, prospective, uncontrolled study.
Patients. - Twenty-one septic shock with NE > 0.5 mu g/kg/min, venous mixed oxygen saturation (ScvO(2)/SvO(2)) > 70%. cardiac index (CI) > 3.5 1/min/m(2) and lactate > 3 mmol/l. Interventions. - Infusion of DPX at 0.5 mu g/kg/min. After 6 hours, patients were classified as DPX-responders or DPX-non-responders according to the presence or not of a decrease >= 20% in lactatemia.
Measurement. - DPX-responders and DPX-non-responders were compared with MAP. Cl, central venous pressure (CVP), heart rate (HR) before infusion of DPX (110), 30 minutes (h0.5) and 6 hours later (h6); and with NE infusion rate at h0 and h6.
Results. - Eleven (52%) patients were DPX-responders and 10(48%) DPX-non-responders. At H0.5, DPX-responders increased MAP more than DPX-non-responders (+21% versus +7%, P = 0.01) with no change in Cl, CVP and HR in both groups. At h0.5, an increase in MAP higher than 14%, compared to h0, could predict lactate clearance at h6 (sensitivity 91%, specificity 90%). From h0 to h6, increase in MAP (80 7 versus 70 +/- 8 mmHg, P < 0.01) in DPX-responders allowed reduction in NE infusion (from 1.6 +/- 0.3 to 0.4 +/- 0.3 mu g/kg/min, P < 0.01): 28-day mortality was lower in DPX-responclers than in DPX-non-responders (7 versus 90%, P < 0.01).
Conclusion. - This study suggests that DPX did induce a decrease in lactatemia in 52% of septic shock, that could be predict by an increase in MAP (> 14% within 30 minutes). Controlled studies are needed to confirm those preliminary results.

• 出版日期2010-11