Clinical and morphological justification of dobutamine use in burn shock
Authors:   Novosibirsk State Medical University, Novosibirsk, Russia, Vereshchagin E.I. , Samatov I.Yu. ,   Novosibirsk State Medical University, Novosibirsk, Russia; Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia, Oshchepkova N.G. ,   Novosibirsk State Medical University, Novosibirsk, Russia, Vostrikov D.N. ,   Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia, Dudin V.I. ,   Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia, Konovalov D.P. ,   Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia, Seliverstov R.I. ,   Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia, Savchenko S.V. ,   Novosibirsk State Medical University, Novosibirsk, Russia
Published: July 2023

Introduction. An effective way to reduce the volume of infusion (restrictive strategy) in hypovolemic shock, in particular in burn shock, is invasive hemodynamic monitoring and choosing the appropriate regimen for the use of inotropic agents, considering the data obtained. However, the use of inotropic agents in hypovolemic shock is still controversial. The most cutting issue is the choice of effective doses of inotropic agents. Aim. Justification of the need to use inotropic agents and assessment of the safety and effectiveness of dobutamine use in burn shock. Materials and methods. The pilot clinical study conducted in 2021–2022 included 9 patients aged 15–70 years who were admitted to the intensive care unit (ICU) of the Burn Center of the Novosibirsk State Regional Clinical Hospital with a total body surface area burned > 40% (II–III degree), in most cases – thermal inhalation injury, who were in the ICU for over 3 days. Intensive care of burn injury in the acute phase was performed according to conventional clinical recommendations. Myocardial samples for morphological and immunohistochemical studies were taken from 34 patients who died from burn shock (27 men and 7 women, aged from 21 to 51 years) from 2015 to 2019. The samples were taken post mortem, and with minimal atherosclerotic changes of the coronary arteries (lesions no more than 20–25%). The control group for morphological and immunohistochemical studies comprised samples which were taken from 25 individuals who died because of sudden circulatory arrest (19 men, 6 women). Results. Studies have shown a decrease in myocardial contractility in patients with burn shock. Morphological examination revealed contraction lesions of individual cardiomyocytes of varying degree, as well as foci of primary clumping of myofibrils’ cytoplasm and myocytolysis. The immunohistochemical study of myocardial sections showed a decrease in the actin expression by 2.4 times (p < 0.05) and desmin – by 2 times (p < 0.05) in comparison with the control group. The results of the clinical study showed that dobutamine at a rate of up to 5.0 μg/kg/min does not cause an arrhythmogenic effect and/or lactic acidosis. Conclusion. The data obtained on structural changes of the myocardium confirm the need for the use of inotropic agent in burn shock. Dobutamine at a rate of up to 5.0 μg/kg/min allows for a restrictive strategy of fluid resuscitation and rapid recovery from burn shock.