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Beneficial hemodynamic effects of prostaglandin Ex infusion in catecholamine-dependent heart failure

1994; Lippincott Williams & Wilkins; Volume: 22; Issue: 7 Linguagem: Inglês

10.1097/00003246-199407000-00006

1530-0293

Richard Pacher, Sebastian Globits, Michael Wutte, Suzanne Rödler, Gottfried Heinz, Gerhard Kreiner, Susanne Radosztics, Rudolf Berger, Isabella Presch, H. Wéber,

Cardiac electrophysiology and arrhythmias

Objective To study the hemodynamic effects of prostaglandin E1: (PGE1)administered in addition to a standard catecholamine infusion in patients with severe chronic heart failure. Design Prospective, placebo-controlled, randomized, single-blind study. Setting Intensive care unit at a university hospital. Patients Thirty patients with severe chronic heart failure, New York Heart Association functional class TV (28 men, two women, with a mean age of 54 ± 2 yrs, mean left ventricular ejection fraction 10 ± 0.6%). All patients received oral therapy with digitalis, furosemide (mean dose 300 ± 46 mg/day), and enalapril (20 ± 2.7 mg/day). Interventions Hemodynamic measurements using pulmonary artery flotation catheters were performed at baseline, ≥24 hrs after standardized catecholamine infusion with dopamine (3 μg/kg/min) and dobutamine (5 μg/kg/min), as well as 48 hrs after randomization to infusion therapy with PGE1 (30 μg/kg/min) or a placebo. Measurements and Main Results The addition of PGE1 to an ongoing catecholamine infusion in 20 patients caused a 16 ± 4% decrease in mean pulmonary arterial pressure (p < .001), a 22 ± 5% decrease in pulmonary artery occlusion pressure (p < .0001), a 24 ± 8% decrease in pulmonary vascular resistance index (p < .001), a 20 ± 9% decrease in right atrial pressure (p < .01), a 14 ± 3% decrease in mean arterial pressure (p < .001), and a 29 ± 4% decrease in systemic vascular resistance index (p < .0001). These PGE1- induced decreases occurred without a change in heart rate. Stroke volume index increased with PGE1 therapy by 34 ± 7% (p < .0001), and cardiac index increased by 34 ± 6% (p < .0001). No hemodynamic changes were observed during combined infusion with catecholamines and placebo in ten patients. Conclusion PGE1 improves the hemodynamic state in end-stage chronic heart failure patients already receiving a standard dose dopamine/ dobutamine infusion. (Crit Care Med 1994; 22:1084–1090)