İleri Kalp Yetersizliğinde Düşük Doz Dobutamin Tedavisinin Servis Koşullarında Başlatılması: Retrospektif Tanımlayıcı Bir Çalışma

Öz

Amaç: İleri evre kalp yetersizliği olan hastalarda, kısa süreli düşük doz dobutamin tedavisinin izlem altında servis koşullarında başlatılmasının güvenlik sonuçlarını değerlendirmek. Gereç ve Yöntemler: Bu retrospektif tek merkezli çalışmaya, 2015–2025 yılları arasında düşük doz dobutamin (72 saat süreyle 2.5–5 µg/kg/dk) alan 121 hasta dahil edildi. Hastalar servis (n=37) ve yoğun bakım ünitesi (YBÜ; n = 84) gruplarına ayrıldı. Birincil sonlanım noktası hayatı tehdit eden aritmiydi. İkincil sonlanım noktaları yeni gelişen supraventriküler aritmi ve tedavi sonrası hipotansiyonu içeriyordu. Bulgular: Hayatı tehdit eden aritmi toplamda 12 hastada (%9,9) gözlendi. Servis grubunda olay izlenmezken (0/37), YBÜ grubunda 12 hastada (%14,3) görüldü (mutlak risk farkı −%14,3; %95 GA −23,3 ile −3,2; p = 0,017). Supraventriküler aritmi oranları benzerdi (%5,4 ve 2,4; p = 0,585). Tedavi sonrası hipotansiyon YBÜ grubunda daha sık saptandı (%20,2 ve 2,7; p = 0,012). Sonuç: Retrospektif tasarım, triyaja dayalı hasta seçimi ve gruplar arasındaki belirgin başlangıç farklılıkları nedeniyle bulgular tanımlayıcı olarak değerlendirilmelidir ve servis ile YBÜ’de dobutamin başlanmasının karşılaştırmalı güvenliğine ilişkin kanıt olarak yorumlanmamalıdır. YBÜ yatış kriterlerini karşılamayan dikkatle seçilmiş hastalarda, yapılandırılmış servis izlemi altında kısa süreli düşük doz dobutamin başlanması uygulanabilir bir yaklaşım olabilir; ancak güvenliğinin ortaya konması için ileriye dönük çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Dobutamin
• kalp yetersizliği
• hasta güvenliği
• mortalite
• kardiyak aritmiler

Destekleyen Kurum

NA

Etik Beyan

Etik Kurul: Çalışma, Antalya Eğitim ve Araştırma Hastanesi Etik Kurulu tarafından onaylanmıştır (onay tarihi: 03 Temmuz 2025; protokol no: 11/3).

Teşekkür

YOK

Ward-Based Initiation of Low-Dose Dobutamine in Advanced Heart Failure: A Retrospective Descriptive Study

Öz

Objective: To evaluate the safety outcomes associated with short-term low-dose dobutamine initiation in a monitored ward setting compared with initiation in the intensive care unit (ICU) in patients with advanced heart failure. Material and Methods: This retrospective single-center study included 121 patients who received low-dose dobutamine (2.5–5 µg/kg/min for 72 hours) between 2015 and 2025. Patients were classified as ward (n=37) or ICU (n=84). The primary endpoint was life-threatening arrhythmia. Secondary endpoints included new-onset supraventricular arrhythmia and post-treatment hypotension. Results: Life-threatening arrhythmia occurred in 12 patients (9.9%) overall. No events were observed in the ward group (0/37), whereas 12 occurred in the ICU group (12/84, 14.3%) (absolute risk difference −14.3%, 95% CI −23.3 to −3.2; p = 0.017). Supraventricular arrhythmia rates were similar (5.4% vs. 2.4%; p = 0.585). Post-treatment hypotension was more frequent in the ICU group (20.2% vs. 2.7%; p = 0.012). Conclusion: Given the retrospective design, triage-based patient selection, and substantial baseline differences between groups, the findings should be interpreted descriptively and do not establish comparative safety between the ward and ICU groups. In carefully selected patients who do not meet ICU admission criteria, short-term low-dose dobutamine initiation under structured ward monitoring may be feasible, but prospective studies are required to establish its safety.

Anahtar Kelimeler

• Dobutamine
• heart failure
• patient safety
• mortality
• cardiac arrhythmias

Destekleyen Kurum

NA

Etik Beyan

Ethic Board: was approved by the Antalya Training and Research Hospital Ethics Committee (approval date: 03 July 2025; protocol no. 11/3

Teşekkür

NO

Kaynakça

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