[Acute right ventricular failure. Treatment with dobutamine]

Acute right ventricular failure is commonly observed during respiratory intensive care, particularly in patients suffering from massive pulmonary embolism, chronic obstructive pulmonary disease or adult respiratory distress syndrome. The haemodynamic effects of a continuous dobutamine infusion at the rate of 9.4 +/- 3.7 micrograms/kg/min were assessed in a group of 15 patients with acute and isolated right ventricular failure, as evidenced by haemodynamic and two dimensional echocardiographic measurements. This inotropic agent induced at 37% increase in mean cardiac index and a 25% increase in mean stroke index, with only a 10% increase in mean heart rate. Moreover, measurement of the right ventricular ejection fraction by a thermal dilution technique performed in 10 patients demonstrated that dobutamine consistently and significantly increased right ventricular systolic function and also significantly reduced right ventricular end-diastolic tension. In conclusion, it appeared that dobutamine was able to improve circulatory status in patients with acute right heart failure or various origins.