What is the role of inotropic therapy in the treatment of multiple organ dysfunction syndrome (MODS) in sepsis?

Updated: Jan 27, 2020
  • Author: Ali H Al-Khafaji, MD, MPH, FACP, FCCP, FCCM; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Although myocardial performance is altered during sepsis and septic shock, cardiac output is usually maintained in patients with sepsis who have undergone volume resuscitation. Data from the 1980s and 1990s suggested a linear relation between oxygen delivery and oxygen consumption (pathologic supply dependency), indicating that oxygen delivery was likely insufficient to meet the metabolic needs of the patient.

However, subsequent investigations challenged the concept of pathologic supply dependency and the practice of elevating cardiac index and oxygen delivery (hyperresuscitation) on the grounds that these interventions have not been shown to improve patient outcome. However, if there is inadequate cardiac index, MAP, mixed venous oxygen saturation, and urine output despite optimal volume resuscitation and vasopressor therapy, a trial of dobutamine infusion up to 20 µg/kg/min be administered or added to vasopressor therapy.


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