From the Department of Anaesthesiology and Intensive Care, East Section, Aarhus University Hospital (KBW, AHS, VKR, ES, PJ-O), and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (KBW, AHS, VKR, ES, PJ-O).
Eur J Anaesthesiol. 2017 May;34(5):262-270. doi: 10.1097/EJA.0000000000000588.
Pleural effusion is a common finding in critically ill patients and may contribute to circulatory instability and the need for inotropic support.
We hypothesised that dobutamine would affect the physiological determinants preload, afterload, contractility and changes of inferior vena cava characteristics during experimental pleural effusion.
A randomised, controlled laboratory study.
Animal laboratory, conducted from March 2013 to May 2013.
Twenty-four Landrace and Yorkshire female piglets (21.3 ± 1.7 kg).
Twenty piglets were included in the analyses. After inducing bilateral pleural effusion (30 ml kg), the piglets were block randomised to either incremental dobutamine infusion (n = 10) or control (n = 10).
Ultrasonographic measures of left ventricular end-diastolic area, left ventricular afterload, left ventricular fractional area change and inferior vena cava diameter and distensibility were used to assess the basic physiological effect of incremental dobutamine administration during experimental pleural effusion.
In the dobutamine group, preload, measured as left ventricular end-diastolic area, decreased from 11.3 ± 2.0 cm after creation of the pleural effusion to 8.1 ± 1.5 cm at a dobutamine infusion rate of 20 μg kg min (P < 0.001). In the same period, central venous pressure and the expiratory diameter of the inferior vena cava decreased from 9 ± 3 to 7 ± 4 mmHg (P < 0.001) and from 1.1 ± 0.2 to 0.9 ± 0.1 cm (P = 0.008), respectively.
In a porcine model of pleural effusion, dobutamine affected basic haemodynamic determinants substantially by decreasing left ventricular preload. Changes in central venous pressure and inferior vena cava characteristics were minimal, discouraging their use as indices of preload. This study underlines the significance of evaluating basic haemodynamic determinants to avoid inappropriate, potentially harmful treatment.
胸腔积液是危重症患者的常见表现，可能导致循环不稳定和需要正性肌力支持。
我们假设多巴酚丁胺会影响实验性胸腔积液期间前负荷、后负荷、收缩力和下腔静脉特征变化的生理决定因素。
随机对照实验室研究。
动物实验室，2013 年 3 月至 2013 年 5 月进行。
24 头长白和约克夏雌性仔猪（21.3±1.7kg）。
20 头仔猪被纳入分析。在诱导双侧胸腔积液（30ml/kg）后，仔猪被随机分为递增多巴酚丁胺输注组（n=10）或对照组（n=10）。
左心室舒张末期面积、左心室后负荷、左心室射血分数和下腔静脉直径及可扩张性的超声测量用于评估实验性胸腔积液期间递增多巴酚丁胺给药的基本生理效应。
在多巴酚丁胺组，前负荷（左心室舒张末期面积）从胸腔积液形成后的 11.3±2.0cm 下降至 20μg/kg/min 多巴酚丁胺输注时的 8.1±1.5cm（P<0.001）。在此期间，中心静脉压和下腔静脉呼气直径分别从 9±3mmHg 下降至 7±4mmHg（P<0.001）和从 1.1±0.2cm 下降至 0.9±0.1cm（P=0.008）。
在猪胸腔积液模型中，多巴酚丁胺通过降低左心室前负荷显著影响基本血液动力学决定因素。中心静脉压和下腔静脉特征的变化很小，不鼓励将其用作前负荷的指标。本研究强调了评估基本血液动力学决定因素以避免不适当、潜在有害治疗的重要性。
