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Low-dose dobutamine after surgery in high-risk patients: effects on postoperative complications

Introduction

Dobutamine may have a role in increasing splanchnic perfusion, thereby protecting this area from further injury. We aimed to investigate the effects of low-dose dobutamine (5 μg/kg/min) on tissue perfusion and postoperative complications in high-risk patients.

Methods

A prospective, randomized, blinded and placebo-controlled study. One hundred surgical patients admitted to a step-down unit were evaluated and 82 patients were enrolled, 42 for the control group (saline) and 40 for the dobutamine group (5 μg/kg/hour during 24 hours). The same therapeutic goals were applied for both groups. The presence of tachycardia or hypotension in response to study drug infusion was considered a signal of occult hypoperfusion and deemed a need for fluid replacement, which was given according to an algorithm.

Results

Complications occurred in 35% and 50% of the patients in the dobutamine and control groups, respectively (RR 0.70, 95% CI 0.41–1.17; not significant). The patients in whom dobutamine was interrupted due to persistent tachycardia despite fluid replacement had more complications (75% vs 40.6%; RR 1.85, 95% CI 1.03–3.29, P < 0.05), higher mortality (62.5% vs 12.5%; RR 5.0, 95% CI 1.72–14.46, P < 0.05) and lower central venous oxygen saturation (55% ± 15% vs 70% ± 16%; P = 0.021) in comparison with patients tolerant to dobutamine infusion.

Conclusion

Low-dose dobutamine after surgical trauma has no effects on the prevalence of postoperative complications in high-risk surgical patients. Morbimortality was significantly higher in patients with severe occult hypoperfusion.

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Lobo, S., Arantes, A., Junior, A.C. et al. Low-dose dobutamine after surgery in high-risk patients: effects on postoperative complications. Crit Care 11, P251 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5411

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Keywords

  • Postoperative Complication
  • Oxygen Saturation
  • Dobutamine
  • Tissue Perfusion
  • Drug Infusion