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Treatment and Prevention of Diaphragm Fatigue Using Low-Dose Dopamine

School of Nursing, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160-7502jpierce{at}kumc.edu

Richard L. Clancy, PhD

Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160-7502.

Nan Smith-Blair, PhD, RN

Eleanor Mann School of Nursing, University of Arkansas, Fayetteville, AK 72701.

Robert Kraft, MD

52552 Skyline Drive, Kansas City, KS 66205.

There is increasing evidence that diaphragm fatigue is a major cause of failure in weaning patients frommechanical ventilation. Patients in intensive care units are often administered dopamine to improve renal blood flow without regard to its effect on diaphragmblood flow. The aimof this study was to investigate if intravenous low-dose dopamine, equivalent to the dose used in intensive care units, can treat and prevent diaphragmfatigue. Diaphragmfatigue was produced in anesthetized rats by inspiratory resistance loading (IRL). The effect on diaphragmshortening, diaphragmblood flow, and aortic blood flow was determined. When diaphragm fatigue was attained, group I was given saline for 30 min while maintaining IRL. At the time of diaphragm fatigue, group II was given low-dose dopamine (2 µg/kg/min) for 30 min while maintaining IRL. In group III, dopamine administration was started before and continued throughout the period of IRL. Administering dopamine after the development of diaphragm fatigue (group II) increased diaphragm performance as measured by increased diaphragmshortening and was accompanied by an increased diaphragmblood flow. Administering dopamine prior to and throughout IRL (group III) prevented diaphragmfatigue. Low-dose dopamine can prevent and/or reverse diaphragmfatigue in rats without a significant change in aortic blood flow. This effect of dopamine may be due to increased oxygen delivery associated with the increased diaphragm blood flow, resulting in less free radical formation and thus less muscle damage.

Key Words: Low-dose dopamine • diaphragm fatigue • diaphragmblood flow

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