Response to Dobutamine in Septic Shock With Myocardial Dysfunction: A Single-Center Retrospective Study
Marwa Tarbaghia, Abdelrahman Nanah, Ryota Sato, Filippo Sanfilippo, Siddharth DugarIMPORTANCE:
Dobutamine is recommended for septic shock with myocardial dysfunction and persistent hypoperfusion despite preload and mean arterial pressure optimization; however, supporting evidence is limited, and predictors of response remain unclear.
OBJECTIVES:
To determine whether early hemodynamic responsiveness to dobutamine is associated with clinical outcomes and whether baseline echocardiographic parameters identify responders.
DESIGN, SETTING, AND PARTICIPANTS:
Single-center retrospective cohort study at a quaternary academic medical center. Adults with septic shock who received concomitant dobutamine with vasopressor therapy and underwent transthoracic echocardiography within 12 hours before dobutamine initiation.
MAIN OUTCOMES AND MEASURES:
Hemodynamic responsiveness was defined as the combination of an increase in central venous oxygen saturation (ScvO 2 ) of at least five percentage points and a reduction in norepinephrine-equivalent (NEE) dose measured at 2 hours after dobutamine initiation. The primary outcome was 28-day ICU mortality. Secondary outcomes included ICU-free days and renal replacement therapy (RRT) requirement.
RESULTS:
Of 104 patients, 37 (36%) met the composite definition of hemodynamic response. Baseline demographics, illness severity, lactate, and baseline vasopressor dose were similar between groups. Beyond the 2-hour window used to define response, separation persisted at 6 hours: responders showed a greater reduction in NEE dose (ΔNEE, −0.13 vs. 0.04 µg/kg/min;
CONCLUSIONS AND RELEVANCE:
In septic shock with myocardial dysfunction, early hemodynamic responsiveness to dobutamine identified a subgroup with a more favorable clinical trajectory. Resting echocardiographic parameters did not identify responders. These findings are hypothesis-generating and require prospective confirmation.