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Dopamine Effects on Diaphragmatic Strength during Acute Respiratory Failure in Chronic Obstructive Pulmonary Disease

Michel Aubier, MD; Daniele Murciano, MD; Yves Menu, MD; Jorge Boczkowski, MD; Hervé Mal, MD; and René Pariente
[+] Article, Author, and Disclosure Information

Requests for Reprints: Michel Aubier, MD, Clinique Pneumologique, Inserm U 226, Hôpital Beaujon, 100 Avenue de Général Leclerc, 92110 Clichy, France.

Current Author Addresses: Drs. Aubier, Murciano, Menu, Boczkowski, Mal, and Pariente: Clinique Pneumologique, Inserm U 226, Hôpital Beaujon, 100 Avenue de Général Leclerc, 92110 Clichy, France.

© 1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(1):17-23. doi:10.7326/0003-4819-110-1-17
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Study Objective: To assess the effects of dopamine, which has an inotropic effect on the myocardium and increases renal and splanchnic blood flow, on diaphragmatic contraction.

Design and Patients: We studied the changes in transdiaphragmatic pressure during electrical bilateral supramaximal stimulation of the phrenic nerves in eight patients with chronic obstructive pulmonary disease during acute respiratory failure. In three patients, changes in diaphragmatic blood flow were also evaluated.

Methods: All patients were intubated and artificially ventilated. Stimulated transdiaphragmatic pressure, cardiac output, evaluated with a Swan Ganz catheter, and diaphragmatic blood flow, evaluated by timed volume collections of left phrenic venous effluent (a catheter was introduced into the right femoral vein and advanced into the left inferior phrenic vein) were measured before dopamine infusion, every 10 minutes after the onset of dopamine infusion (10 µg/kg body weight · min during 30 minutes) and 15 minutes after the end of dopamine infusion. Arterial blood gases and pH were measured before arid at the end of dopamine infusion.

Measurements and Main Results: Arterial blood gases and pH were maintained within normal range by mechanical ventilation throughout the study. With dopamine infusion, heart rate increased by 17% (P < 0.001) and cardiac output by 40% (P < 0.001) on the average. The increase in cardiac output was accompanied by a marked increase in diaphragmatic blood flow (30% on the average) in the three patients in whom it was measured (P < 0.001). Diaphragmatic strength also increased significantly during dopamine administration. Transdiaphragmatic pressure for an identical phrenic stimulation increased by 30% (P < 0.001) on the average. The changes in cardiac output, diaphragmatic blood flow, and transdiaphragmatic pressure persisted throughout the infusion period; all values returned to control values 15 minutes after the end of dopamine administration.

Conclusions: Dopamine has a potent effect on diaphragmatic strength generation and diaphragmatic blood flow in patients with chronic obstructive pulmonary disease during acute respiratory failure. It is possible to improve diaphrag-contraction in these patients by administering pharmacologic agents that augment diaphragmatic blood flow.





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