- synthetic isoprenaline derivative
- adrenergic agonist
- racemic mixture
Mechanism of Action
- levo: alpha 1 agonist -> vasoconstriction + beta 2 effects -> inotropy
- dextro: beta 1 and beta 2 agonist + alpha 1 blocking effects
-> inotropy with some vasodilation
- 1-40mcg/kg/min, onset = minutes
- 250mg/20mL (with meta-bisulfite),
- racemic mixture of levo and dextro enantiomers
- for low Q states from:
- cardiac surgery
- Septic shock
- cardiac stress testing
-> increases contractility
-> little effect on HR, SVR and PVR
- pulmonary artery vasodilation
- increase HR-> dysrhythmias
- Absorption – IV
- Distribution – Vd small,
- Metabolism – hepatic, methylated (COMT) and conjugated
- Elimination – t1/2 = 2 min, urine and faeces
No evidence that Dobutamine is to be used in any situation over other similar agents.
Mebazza, (2007) SURVIVE – Levosimendan vs Dobutamine in patients with acute decompensated heart failure, JAMA
- n = 1320
- -> no difference in 180 day mortality
Read, M.C. (2008) – “The case for Dobutamine” Critical Care and Resuscitation, Volume 10 (3) page 179
- few metabolic adverse effects
- increases heart rate while causing vasodilation
- increases myocardial consumption but also increases coronary perfusion
- no lactic acidosis
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of LITFL.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
On Twitter, he is @precordialthump.