OBJECTIVE: To evaluate the pharmacokinetics and pharmacodynamics of dobutamine in critically ill children. DESIGN: A prospective study of pediatric patients receiving continuous infusions of dobutamine in a stepwise format from 2.5 to 10.0 micrograms/kg/min. SETTING: A pediatric critical care unit. PATIENTS: Twelve children ranging in age from 1 month to 17 yrs with primary medical conditions. MEASUREMENTS: Plasma dobutamine concentrations and hemodynamic responses were measured at each infusion rate at steady state. Dose response data were analyzed to determine the threshold or minimum plasma dobutamine concentration necessary for discernible hemodynamic effects. MAIN RESULTS: Dobutamine plasma clearance rates ranged from 40 to 130 mL/kg/min. Each patient presented a linear increase in the plasma dobutamine concentration at each infusion rate (r2 = .97, p less than .001). Plasma clearance rate vs. actual dobutamine concentration did not vary. Cardiac output, BP, and heart rate increased 30%, 17%, and 7%, respectively, at maximal dose. The dobutamine concentration thresholds for changes in cardiac output, BP, and heart rate were 13 +/- 6, 23 +/- 14, and 65 +/- 30 ng/mL, respectively. CONCLUSIONS: There was no effect of plasma dobutamine concentration or infusion rate on plasma clearance rate. For this group of patients, over the range of the intravenous doses studied, dobutamine pharmacokinetics followed a first-order kinetic model. Threshold values for dobutamine usually show increases in cardiac output before changes in heart rate. These data demonstrate that dobutamine is an effective inotropic agent in critically ill pediatric patients and has minimal chronotropic action.
OBJECTIVE: To evaluate the pharmacokinetics and pharmacodynamics of dobutamine in critically ill children. DESIGN: A prospective study of pediatric patients receiving continuous infusions of dobutamine in a stepwise format from 2.5 to 10.0 micrograms/kg/min. SETTING: A pediatric critical care unit. PATIENTS: Twelve children ranging in age from 1 month to 17 yrs with primary medical conditions. MEASUREMENTS: Plasma dobutamine concentrations and hemodynamic responses were measured at each infusion rate at steady state. Dose response data were analyzed to determine the threshold or minimum plasma dobutamine concentration necessary for discernible hemodynamic effects. MAIN RESULTS:Dobutamine plasma clearance rates ranged from 40 to 130 mL/kg/min. Each patient presented a linear increase in the plasma dobutamine concentration at each infusion rate (r2 = .97, p less than .001). Plasma clearance rate vs. actual dobutamine concentration did not vary. Cardiac output, BP, and heart rate increased 30%, 17%, and 7%, respectively, at maximal dose. The dobutamine concentration thresholds for changes in cardiac output, BP, and heart rate were 13 +/- 6, 23 +/- 14, and 65 +/- 30 ng/mL, respectively. CONCLUSIONS: There was no effect of plasma dobutamine concentration or infusion rate on plasma clearance rate. For this group of patients, over the range of the intravenous doses studied, dobutamine pharmacokinetics followed a first-order kinetic model. Threshold values for dobutamine usually show increases in cardiac output before changes in heart rate. These data demonstrate that dobutamine is an effective inotropic agent in critically ill pediatric patients and has minimal chronotropic action.
Authors: Joe Brierley; Joseph A Carcillo; Karen Choong; Tim Cornell; Allan Decaen; Andreas Deymann; Allan Doctor; Alan Davis; John Duff; Marc-Andre Dugas; Alan Duncan; Barry Evans; Jonathan Feldman; Kathryn Felmet; Gene Fisher; Lorry Frankel; Howard Jeffries; Bruce Greenwald; Juan Gutierrez; Mark Hall; Yong Y Han; James Hanson; Jan Hazelzet; Lynn Hernan; Jane Kiff; Niranjan Kissoon; Alexander Kon; Jose Irazuzta; Jose Irazusta; John Lin; Angie Lorts; Michelle Mariscalco; Renuka Mehta; Simon Nadel; Trung Nguyen; Carol Nicholson; Mark Peters; Regina Okhuysen-Cawley; Tom Poulton; Monica Relves; Agustin Rodriguez; Ranna Rozenfeld; Eduardo Schnitzler; Tom Shanley; Saraswati Kache; Sara Skache; Peter Skippen; Adalberto Torres; Bettina von Dessauer; Jacki Weingarten; Timothy Yeh; Arno Zaritsky; Bonnie Stojadinovic; Jerry Zimmerman; Aaron Zuckerberg Journal: Crit Care Med Date: 2009-02 Impact factor: 7.598
Authors: J J Ferrara; D L Dyess; G L Peeples; D P Christenberry; W S Roberts; E J Tacchi; A N Swafford; J L Ardell; R W Powell Journal: Ann Surg Date: 1995-05 Impact factor: 12.969