Issues in Respiratory Nursing| Volume 32, ISSUE 2, P111-120, March 2003

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The effect of dobutamine infusion on fractional diaphragm thickening and diaphragm blood flow during fatigue


      Background: Diaphragm fatigue (DF) has been implicated in respiratory failure in diseases that increase inspiratory resistance loading (IRL) and may complicate weaning of patients from mechanical ventilation. Objective: The purpose of this study was to examine the effects of dobutamine administration (10 μg/kg/min) on DF and to identify the mechanisms by which dobutamine augments diaphragm shortening and diaphragm blood flow (DBF) during fatigue with a rat model. Methods: The study had an experimental design with 3 groups of Sprague-Dawley rats (n = 38) with 4 experimental periods: period 1, control; period 2, application of IRL; period 3, treatment; and period 4, recovery. DF was produced via IRL. During period 3 treatment, normal saline solution was infused in group I, dobutamine in group II, and dobutamine plus butoxamine hydrochloride in group III. The percent change in fractional diaphragm thickness (FDT) during inspiration reflected diaphragm shortening. DBF and aortic blood flow were determined with fluorescent microspheres. Diaphragm vascular resistance and systemic vascular resistance were calculated on the basis of Poiseuille's equation. Results: Results indicated infusion of dobutamine increased FDT (P =.01) and DBF (P =.009) with respect to fatigue levels. The effects of dobutamine on FDT and DBF were attenuated with infusion of butoxamine hydrochloride (a β-2 adrenoceptor antagonist) with respect to fatigue. Conclusion: Administration of dobutamine at a rate similar to that used clinically increased diaphragm muscle contractility (FDT) and DBF in diaphragms fatigued by IRL. The dobutamine effect on FDT may be the result of restoration of the balance between diaphragm energy consumption and energy delivery to the diaphragm by increasing DBF. Butoxamine hydrochloride attenuated the dobutamine-induced increase in DBF, indicating dobutamine produced vasodilatation via β-2 adrenoceptors. Thus, the administration of intravenous dobutamine may be a useful adjunct in the treatment of DF. (Heart Lung® 2003;32:111-20.)
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        • Bellemare F
        • Grassino A
        Force reserve of the diaphragm in patients with COPD.
        J Appl Physiol. 1983; 55: 8-15
        • Cohen CA
        • Zagelbaum G
        • Gross D
        • Roussos C
        • Macklem PT
        Clinical manifestations of inspiratory muscle fatigue.
        Am J Med. 1982; 73: 308-316
        • Levine S
        • Guillen M
        Diaphragmatic pressure waveform can predict EMG signals of diaphragmatic fatigue.
        J Appl Physiol. 1987; 62: 1681-1689
        • National Heart, Lung and Blood Institute NHLBI
        Workshop summary respiratory muscle fatigue.
        Am Rev Resp Dis. 1990; 142: 474-480
        • Ebata T
        • Fujii Y
        • Toyooka H
        Dobutamine increases diaphragmatic contractility in dogs.
        Can J Anaesth. 1992; 39: 375-380
        • Fujii Y
        • Toyooka H
        • Toshiya E
        • Amaha K
        Contractility of fatigued diaphragm is improved by dobutamine.
        Can J Anaesth. 1993; 40: 453-458
        • Howell S
        • Roussos C
        Isoproterenol and aminophylline improve contractility of fatigue canine diaphragm.
        Am Rev Respir Dis. 1984; 129: 118-124
        • Aubier M
        • Viires N
        • Murciano D
        • Medrano G
        • Lecocguic Y
        • Pariente R
        Effects and mechanism of action of terbutaline on diaphragmatic contractility and fatigue.
        J Appl Physiol. 1984; 56: 922-929
        • Armstrong RB
        • Laughlin MH
        Blood flows within and among rat muscles as a function of time during high speed treadmill exercise.
        J Physiol. 1983; 344: 189-208
        • Armstrong RB
        • Laughlin MH
        Exercise blood flow patterns within and among rat muscles after training.
        Am J Physiol. 1984; 246: H59-H68
        • Poole DC
        • Gaesser GA
        • Hogan MC
        • Knight DR
        • Wagner PD
        Correspondence of pulmonary and leg VO2 at submaximal work rates: implications for estimation of work efficiency.
        J Appl Physiol. 1992; 72: 805-810
        • Abdelrahman A
        • Tabrizchi R
        • Pang CCY
        Effects of β1-and β2-adrenoceptor stimulation on hemodynamics in the anesthetized rat.
        J Cardiovasc Pharmacol. 1990; 15: 720-728
        • Chang HY
        Response of nitric oxide in vasodilator response induced by salbutamol in rat diaphragmatic microcirculation.
        Am J Physiol. 1997; 272: H2173-H2179
        • Jensen J
        • Brors O
        • Dahl HA
        Different β-adrenergic receptor density in different rat skeletal muscle fibre types.
        Pharmacol Toxicol. 1995; 76: 380-385
        • Martin III, WH
        • Murphree SS
        • Saffitz JE
        β-adrenergic receptor distribution among muscle fiber types and resistance arterioles of white, red, and intermediate skeletal muscle.
        Circ Res. 1989; 64: 1096-1105