dobutamine infusion

My 85 year old father has CHF. Previously had quad bypass and valve repair, prostate cancer, bladder cancer and mult. myaloma.  All cancers have been in remission for years.  Recently despite low salt diet he continues to retain fluid.  Since Jan. we've had to hospitalize him 3 times to get fuid off.  He is 5'9' 185 lbs and is very deconditioned....not able to do anything.    Tomorrow he is getting a pleurovac.  Neph wants to try dobutamine infusion, card. says send him home and keep him comfortable.  Very motivated pt.  I can't find any info on how long pts. put on dobutamine infusion last?  Can anyone help me.  He really prefers quality of life vs. longevity.

[Dr_Veena]

Hi,
     Fluid retention can be due to various reasons like heart failure, low serum protein, renal failure, liver failure etc. Your father needs to get evaluated for the above mentioned causes to find out the cause for fluid build up in your father. Depending upon the cause treatment varies. Dobutamine is a inotrope, as a support in the short-term treatment of cardiac decompensation due to depressed contractility resulting either from organic heart disease or from cardiac surgical procedures. Diuretics, fluid restriction and cardiac drugs are helpful in coping with this situation. Best.

[dblscoop]

Thank you Dr. Veena.  My father has mild kidney impairment from jump starting him after bypass.  He takes lasix 80 mg BID and when his weight is up he takes 160 BID for 3 days.  They have removed 1800 cc, then another 2 full bottles from the pleurovac (which I believe the bottle holds 600cc).  Right now they are beginning aggressive physical therapy to see how he does then they will evaluate for other options.  Can you tell me when they say Dobutamine causes an increase in mortality how long those pts typically live?

Thank you again.

[Dr_Veena]

Hi,
      As, mentioned in the earlier post, Dobutamine infusion is a supportive measure to help the heart function better and not a palliative treatment. Patient’s do come out of this stage, but this depends upon various other factors influencing his general condition like renal parameters in your father’s case. Does he have fluid build up only in the lungs or every where in the body? If only in the lungs then the fluid should be examined for pus cells or any abnormal cells. As, there is a history of multiple tumors secondaries can develop which can also lead to recurrent pleural effusion.
Lastly, he needs to check his renal parameters, follow fluid restriction with advice of his nephrologist and try Dobutamine to improve this situation. Best.