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BJA Advance Access originally published online on February 27, 2008
British Journal of Anaesthesia 2008 100(4):494-503; doi:10.1093/bja/aen017
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 BJA: April 2008
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Effects of short-term simultaneous infusion of dobutamine and terlipressin in patients with septic shock: the DOBUPRESS study{dagger}

A. Morelli1,*, C. Ertmer2, M. Lange2, M. Dünser3, S. Rehberg2, H. Van Aken2, P. Pietropaoli1 and M. Westphal2

1 Department of Anesthesiology and Intensive Care, University of Rome ‘La Sapienza’, Viale del Policlinico 155, 00161 Rome, Italy
2 Department of Anesthesiology and Intensive Care, University Hospital of Muenster, Albert-Schweitzer-Str. 33, 48149 Muenster, Germany
3 Department of Intensive Care Medicine, University of Bern, 3010 Bern, Switzerland

* Corresponding author. E-mail: andrea.morelli{at}uniroma1.it

Background: Terlipressin bolus infusion may reduce cardiac output and global oxygen supply. The present study was designed to determine whether dobutamine may counterbalance the terlipressin-induced depression in mixed-venous oxygen saturation (SvO2) in patients with catecholamine-dependent septic shock.

Methods: Prospective, randomized, controlled study performed in a university hospital intensive care unit. Septic shock patients requiring a continuous infusion of norepinephrine (0.9 µg kg–1 min–1) to maintain mean arterial pressure (MAP) at 70 (SD 5) mm Hg were randomly allocated to be treated either with (i) sole norepinephrine infusion (control, n=20), (ii) a single dose of terlipressin 1 mg (n=19), or (iii) a single dose of terlipressin 1 mg followed by dobutamine infusion titrated to reverse the anticipated reduction in SvO2 (n=20). Systemic, pulmonary, and regional haemodynamic variables were obtained at baseline and after 2 and 4 h. Laboratory surrogate markers of organ (dys)function were tested at baseline and after 12 and 24 h.

Results: Terlipressin (with and without dobutamine) infusion preserved MAP at 70 (5) mm Hg, while allowing to reduce norepinephrine requirements to 0.17 (0.2) and 0.2 (0.2) µg kg–1 min–1, respectively [vs1.4 (0.3) µg kg–1 min–1 in controls at 4 h; each P<0.001]. The terlipressin-linked decrease in SvO2 was reversed by dobutamine at a mean dose of 20 (8) µg kg–1 min–1 [SvO2 at 4 h: 59 (11)% vs 69 (12)%, P=0.028].

Conclusions: In human catecholamine-dependent septic shock, terlipressin (with and without concomitant dobutamine infusion) increases MAP and markedly reduces norepinephrine requirements. Although no adverse events were noticed in the present study, potential benefits of increasing SvO2 after terlipressin bolus infusion need to be weighted against the risk of cardiovascular complications resulting from high-dose dobutamine.

Keywords: arterial pressure, drug effects; complications, vasoconstriction; intensive care; oxygen, transport

{dagger} This study was performed in the Intensive Care Unit of the Department of Anesthesiology and Intensive Care of the University of Rome, ‘La Sapienza’.


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A. Miller, N. Coleman, A. Morelli, C. Ertmer, and M. Westphal
Dobutamine and terlipressin in patients with septic shock
Br. J. Anaesth., July 1, 2008; 101(1): 125 - 126.
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Dobutamine and terlipressin in patients with septic shock
Ashley Miller, et al.
British Journal of Anaesthesia, 23 Apr 2008 [Full text]
Re: Dobutamine and terlipressin in patients with septic shock
Andrea Morelli
British Journal of Anaesthesia, 4 May 2008 [Full text]

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