Dobutamine (ICU — Inotrope)

How it works

It is a synthetic catecholamine that predominantly stimulates beta-1 adrenoceptors in the myocardium, increasing the force of cardiac contraction (positive inotropy) and, to a lesser extent, heart rate, thereby raising cardiac output.

Prescribing in practice

• Administer only via an infusion pump with continuous cardiac and haemodynamic monitoring, as it can provoke tachycardia, arrhythmias and myocardial ischaemia.
• Correct hypovolaemia before starting, since dobutamine increases contractility but does not reliably support an inadequate circulating volume.
• It can cause vasodilatation and a fall in blood pressure, particularly in volume-depleted patients.

Monitoring

Monitor ECG, heart rate, blood pressure and indices of perfusion or cardiac output continuously during the infusion.

Counselling the patient

• Team: titrate to haemodynamic targets and watch for tachyarrhythmia and ischaemia.
• Team: ensure adequate intravascular volume before and during infusion.

Evidence & guidelines

Dobutamine is an established first-line inotrope for low cardiac output states in critical care and is recommended in heart-failure guidance for selected patients.