CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by NOBLE, W. H.
Right arrow Articles by KAY, J. C.
Right arrow Search for Related Content
PubMed
Right arrow Articles by NOBLE, W. H.
Right arrow Articles by KAY, J. C.

Canadian Journal of Anesthesia, Vol 33, 48-56, Copyright © 1986 by Canadian Anesthesiologists' Society

The Effects of Dobutamine, Nitroprusside, or Volume Expansion on Cardiac Output and Lung Water After CPPV

WILLIAM H. NOBLE MD FRCPC1 and J. COLIN KAY AIMLT1

1 Department of Anaesthesia, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8

Address correspondence to: Dr. W.H. Noble, at the above address.

Pulmonary microemboli can create an ARDS-like state in dogs (high pulmonary vascular resistance, pulmonary oedema and arterial hypoxemia). CPPV can correct the hypoxemia of pulmonary microemboli but reduces cardiac output (Q·) and tissue oxygenation. This paper compares the effect of improving Q· by infusing volume, reducing afterload, or increasing myocardial contractility. Four groups of seven dogs were studied. All had 0.125 g·kg-1 of starch microemboli (63-74 microns) infused and then CPPV at 15 cm H2O applied. The control group had no further treatment applied. In three other groups volume (dextran) or dobutamine or nitroprusside (NTP) was infused to return Q· to the level before CPPV was applied. All treatments (volume, dobutamine and NTP) improved Q· and O2 transport. Only the volume group had a significant increase in pulmonary microvascular pressure, Pmv = PLA + 0.4(PPA - PLA) from 2.53 ± 0.27 to 3.35 ± 0.13 kPa, p < 0.05. Only the volume group demonstrated a significant increase in lung water above (double) the control group as measured by a double indicator dilution technique (ETVL) and postmortem lung weights. We conclude volume infusions to improve a CPPV depressed Q· may increase lung water and that better treatment would be to infuse NTP or dobutamine, thus maintaining a lower Pmv and therefore lung water. As a corollary the least CPPV should be applied to maintain adequate oxygenation and create the least need for interventions to improve Q·.

Key Words: HEART: cardiac output • LUNG: oedema • VENTILATION: continuous positive pressure • SYMPATHETIC NERVOUS SYSTEM: dobutamine • PHARMACOLOGY: nitroprusside






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1986 by the Canadian Anesthesiologists' Society.