CLINICAL RESEARCH: PEDIATRIC CARDIOLOGY
Adverse Effects of Dopamine on Systemic Hemodynamic Status and Oxygen Transport in Neonates After the Norwood Procedure
Jia Li, MD, PhD,
Gencheng Zhang, MD, PhD,
Helen Holtby, MBBS,
Tilman Humpl, MD,
Christopher A. Caldarone, MD,
Glen S. Van Arsdell, MD and
Andrew N. Redington, MD*
Cardiac Program, the Hospital for Sick Children, Toronto, Ontario, Canada.
Manuscript received March 31, 2006;
revised manuscript received June 26, 2006,
accepted July 10, 2006.
* Reprint requests and correspondence:
Dr. Andrew N. Redington, Division of Cardiology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. (Email: andrew.redington{at}sickkids.ca).
OBJECTIVES: The purpose of this study was to evaluate the effects of dopamine on hemodynamic status and oxygen transport in neonates after the Norwood procedure.
BACKGROUND: Dopamine is widely used to augment cardiac performance and increase oxygen delivery (DO
2
) in patients after cardiopulmonary bypass (CPB). This might be at the expense of increased myocardial and systemic oxygen consumption (VO
2
), thus offsetting the improved DO
2
. This balance is particularly fragile in critically ill neonates.
METHODS: Systemic oxygen consumption was continuously measured with respiratory mass spectrometry in 13 sedated, paralyzed, and mechanically ventilated neonates for 72 h after the Norwood procedure. Arterial, superior vena caval, and pulmonary venous blood gases were measured to calculate pulmonary blood flow (Qp
) and systemic blood flow (Qs
), DO
2
, and oxygen extraction ratio (ERO
2
). Rate-pressure product was calculated. Dopamine at a dose of 5 µg/kg/min was routinely administered at cessation of CPB and terminated within the first 48 h. Hemodynamic and oxygen transport measures were obtained before and at 100 min after the termination of dopamine.
RESULTS: Terminating dopamine was not associated with significant changes in arterial pressure, Qp
, Qs
, or DO
2
but was associated with a significant decrease in heart rate (p = 0.003), rate-pressure product (p = 0.03), and VO
2
(–20 ± 11%, p < 0.0001), resulting in a significant decrease in ERO
2
(p = 0.01).
CONCLUSIONS: Dopamine induces a significant increase in VO
2
in neonates after the Norwood procedure, and termination is associated with an improved balance of VO
2
–DO
2
. These data further emphasize the importance of understanding changes in VO
2
as well as DO
2
in infants after cardiac surgery.
|
Abbreviations and Acronyms
| | BT-PVR = pulmonary vascular resistance inclusive of the Blalock-Taussig shunt | | CO = total cardiac output | | CPB = cardiopulmonary bypass | | DO
2
= systemic oxygen delivery | | ERO
2
= oxygen extraction ratio | | Qp
= pulmonary blood flow | | Qs
= systemic blood flow | | SVR = systemic vascular resistance | | VO
2
= systemic oxygen consumption |
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