The increased cardiac output was associated with reduced PAWP after dobutamine but with increased PAWP after dopamine. Improvement in tissue perfusion indicated by increased Do2 and Vo2 were demonstrated after various doses of dobutamine in critically ill general surgical patients; however, in patients with sepsis, Jardin et al found dobutamine reduced C(a-v)02 but did not significantly improve Vo2; dobutamine increased Qsp without PEEP but did not increase Qsp in patients with PEEP of 9±4 cm H20. In previous studies, we have empirically observed increased Cl, Do2, and Vo2 to median values of 4.5 L/min/sq m, 600 ml/min/sq m, and 170 ml/min/sq m, respectively, in surviving high-risk surgical patients during their early postoperative peak. In nonsurvivors, by contrast, the mean values of these three variables fell within the normal range during the first four days after surgery. Reading here
The other hemodynamic and oxygen transport variables were similar, ie, the differences between survivors and nonsurvivors did not have appreciable predictive importance. This suggests that these supranormal values reflect compensatory circulatory responses to the increased metabolic demands of critical illness and are, therefore, the appropriate goals of therapy. The hypothesis that supranormal values in survivors are the appropriate therapeutic goals was tested prospectively and led to improved outcome. Our present approach, therefore, requires that fluids and then pharmacologic agents be used to obtain these values as optimal therapeutic goals. The present report describes and compares the hemodynamic and oxygen transport effects of dopamine and dobutamine in a prospective, randomized, crossover designed series of critically ill, postoperative, general surgical patients after maximal response to fluids had been obtained.