Left Ventricular Volume Index in the Adjustment of Initial Dose of Dobutamine in Heart Failure and Cardiogenic Shock

Use of Transtoracic Ecocargiogram With Calculation of Left Ventricular Volume Index in the Initial Adjustment of Initial Dose of Dobutamine in Patients With Heart Failure and Cardiogenic Shock

Recent studies have suggested that the use of left ventricular ejection volume index calculation may aid in the hemodynamic management of critically ill patients. However, a prospective and randomized comparison in patients with heart failure for inotropic dose adjustment has not been described. The objective of this study was to evaluate the efficacy and safety of ejection volume index versus liberal strategy in adjusting dobutamine dose in patients with heart failure and low cardiac output. Methodology: A unicentric, randomized and prospective study will be performed in a comparative manner. Hospital data (test results, medical outcomes, dobutamine dose, complications) of patients will be analyzed for safety and effectiveness. Expected results: The use of ejection volume index is not inferior to the liberal strategy in the initial adjustment of the dose of dobutamine in patients with heart failure.

Inclusion Criteria:

• LVEF ≤ 40% documented on echocardiography

• BNP> 500 pg / mL

• Need for initiation of dobutamine and signs or symptoms of low cardiac output at admission defined by the presence of 2 or more of the following:

  • SBP ≤ 95 mmHg
  • FC> 100 bpm
  • Peripheral vasoconstriction,
  • Cold extremities,
  • Reference of decrease of urine output,
  • Nausea, vomiting and food intolerance,
  • Presence of organic dysfunction

Exclusion Criteria:

• Pregnancy.
• COPD
• Hepatical cirrhosis
• Atrioventricular block of 2nd or 3rd degree. and. SBP <80 mmHg or need for vasopressor.
• Use of definitive pacemaker.
• Body mass index greater than 40 kg / m2.
• Use of oral anticoagulant.
• Acute coronary syndrome.
• Indication of use of another inotropic other than dobutamine.
• Orotracheal intubation.
• Presence of significant pericardial effusion.
• Obstruction of left ventricular outflow tract.
• Serum creatinine> 5.0 mg / dL or hemodialysis.
• Presence of 2 or more clinical / laboratory / radiological criteria of infection