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La dopamina disminuye la ventilación por minuto en pacientes con insuficiencia cardíaca
P van de Borne1, R Oren, V K Somers
1Department of Internal Medicine and the Cardiovascular Center, University of Iowa Hospitals and Clinics, Iowa City, USA.
Circulation
|July 29, 1998
Resumen
Las dosis bajas de dopamina afectan la respuesta del cuerpo a la falta de oxígeno en individuos sanos y pueden reducir la respiración en pacientes con insuficiencia cardíaca. Este efecto puede tener un impacto negativo en los resultados de los pacientes con hipoxia, particularmente aquellos con insuficiencia cardíaca.
Área de la Ciencia:
- Fisiología cardiovascular fisiología cardiovascular.
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Fisiología de las vías respiratorias.
Sus antecedentes:
- La dopamina en dosis bajas se administra comúnmente en entornos de cuidados intensivos.
- La administración de dopamina puede reducir potencialmente la sensibilidad quimiorrefleja a la hipoxia mediante la inhibición de los aferentes de los quimiorreceptores.
Objetivo del estudio:
- Investigar los efectos de dosis bajas de dopamina en las respuestas cardiorrespiratorias durante la normoxia e hipoxia en sujetos sanos.
- Para examinar el impacto de la dopamina en la ventilación en pacientes con insuficiencia cardíaca grave.
Principales métodos:
- Se realizó un estudio doble ciego, aleatorizado y cruzado en 10 sujetos jóvenes sanos.
- Las mediciones incluyeron la saturación de oxígeno, la ventilación por minuto y la actividad del nervio simpático durante la normoxia e hipoxia.
- Las respuestas respiratorias a la dopamina también se evaluaron en 8 pacientes con insuficiencia cardíaca grave y en 8 controles de la misma edad.
Principales resultados:
- En sujetos sanos, la dopamina no alteró la ventilación por minuto durante la normoxia, pero la redujo durante la hipoxia (12,9 frente a 15,8 L/min).
- La saturación de oxígeno hipoxico fue más baja con dopamina (78%) en comparación con el placebo (84%).
- La dopamina deprimió la ventilación en pacientes con insuficiencia cardíaca, pero no en los controles, con disminuciones asociadas en la saturación de oxígeno y aumento de PETCO2.
Conclusiones:
- Las dosis bajas de dopamina inhiben las respuestas quimiorreflexas a la hipoxia en humanos, afectando principalmente la ventilación sobre la actividad simpática.
- La dopamina también disminuye la ventilación en pacientes con insuficiencia cardíaca normóxica.
- La inhibición ventilatoria causada por la dopamina puede empeorar los resultados en pacientes con hipoxia, especialmente aquellos con insuficiencia cardíaca.
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