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Previous Volume 330:1717-1722 June 16, 1994 Number 24 Next

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ABSTRACT

Background Elevation of systemic oxygen delivery and consumption has been associated with an improved outcome in critically ill patients. We conducted a randomized trial to determine whether boosting oxygen delivery by infusing the inotropic agent dobutamine would improve the outcome in a diverse group of such patients.

Methods On the basis of previously published recommendations, we established the following goals: a cardiac index above 4.5 liters per minute per square meter of body-surface area, oxygen delivery above 600 ml per minute per square meter, and oxygen consumption above 170 ml per minute per square meter. If these goals were not achieved with volume expansion alone, patients were randomly assigned to a treatment or control group. The treatment group received intravenous dobutamine (5 to 200 µg per kilogram of body weight per minute) until all three goals had been achieved. Dobutamine was administered to the control group only if the cardiac index was below 2.8 liters per minute per square meter.

Results A total of 109 patients were studied. In nine patients the therapeutic goals were achieved with volume expansion alone; all nine patients survived to leave the hospital. Fifty patients were randomly assigned to the treatment group, and 50 to the control group. During treatment, there were no differences between the two groups in mean arterial pressure or oxygen consumption, despite a significantly higher cardiac index and level of oxygen delivery in the treatment group (P<0.05). Although the predicted risk of death during hospitalization was 34 percent for both groups, the in-hospital mortality was lower in the control group (34 percent) than in the treatment group (54 percent) (P = 0.04; 95 percent confidence interval, 0.9 to 39.1 percent).

Conclusions The use of dobutamine to boost the cardiac index and systemic oxygen delivery failed to improve the outcome in this heterogeneous group of critically ill patients. Contrary to what might have been expected, our results suggest that in some cases aggressive efforts to increase oxygen consumption may have been detrimental. .

Source Information

From the Departments of Anesthesia and Intensive Care, St. Bartholomew's Hospitals at Smithfield and Homerton (M.A.H., A.C.T., E.H.S.Y., C.J.H., D.W.), and the Departments of Anesthesia and Intensive Care, Charing Cross Hospital (M.P.) -- all in London.

Address reprint requests to Dr. Watson at the Department of Anesthesia, St. Bartholomew's Hospital at Smithfield, West Smithfield, London EC1A 7BE, United Kingdom.

Full Text of this Article

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Elevation of Systemic Oxygen Delivery in the Treatment of Critically Ill Patients
Vincent J.-L., Bihari D. J., Bohrer H., Schmidt H., Bach A., Shoemaker W. C., Appel P. L., Hayes M. A., Palazzo M., Hinds C. J., Watson D.
Extract | Full Text  
N Engl J Med 1994; 331:1160-1162, Oct 27, 1994. Correspondence

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