Journal Club - Recent Additions

February - 2012


Showing Journal 1 of 15

Dobutamine for patients with severe heart failure: a systematic review and meta-analysis of randomised controlled trials

Catherine L. Tacon, John McCaffrey, Anthony Delaney Intensive Care Med, 2012, 38:359


This meta-analysis examines the evidence for dobutamine in the setting of severe heart failure. That is, the question we struggle with of "is it good or bad for the failing heart to make it work harder with dobutamine?".

Overall there was no difference in mortality, which was not changed...


Previous Comments

One of the problems with the inotrope studies in general is that there is no widely accepted mechanism of measuring what it is we're trying to do with them - improve flow to the tissues. Until a technique is developed that is reliable, accurate and widely accepted that measures this directly, its unlikely that we're going to see any mortality benefit at all.
James O'Connor-27 Feb, 2012 02:04:02 PM

This meta-analysis is (to my mind) is not compellingly useful to the intensivist, and misses the point somewhat. Of the 14 included trials, 11 were in outpatients (i.e. not what most of use would think when we think decompensated heart failure or even cardiogenic shock). Secondly, the most interesting paper I have seen on the management of cardiogenic shock in the last year is the the SOAP II trial- comparing dopamine to noradrenaline for all forms of shock, finding no difference except in the pre-specified sub-group of cardiogenic shock - where norad was superior due to a lower rate of tachydysrythmia. The question of whether preventing tachydysrythmia is important seems compelling, and one which has also been intimated at by levosemindan trials.
Matthew Bailey-29 Feb, 2012 10:36:57 AM