Wednesday August 23, 2006
Is Dopamine phasing out?

Standard guidelines regarding vasopressor and inotropic support in septic shock states: "Either norepinephrine or dopamine (through a central catheter as soon as possible) is the first-choice vasopressor agent to correct hypotension in septic shock." 1 But overall trend is towards using norepinephrine as the first-choice vasopressor to correct hypotension in septic shock after fluid resuscitation 2, 3, 4.

In March issue of Critical Care Medicine, part of SOAP (Sepsis Occurrence in Acutely Ill Patients) study looked into multiple-center observation of 1,058 patients with shock 5.

Patients were followed up until death, until hospital discharge, or for 60 days. Of patients in shock, 375 received dopamine (dopamine group) and 683 never received dopamine. The dopamine group had higher ICU (42.9% vs. 35.7%,) and hospital (49.9% vs. 41.7%,) mortality rates. It also showed diminished 30 day-survival in the dopamine group. In a multivariate analysis, dopamine administration was found to be an independent risk factors for ICU mortality in patients with shock.

Study suggests that dopamine administration may be associated with increased mortality rates in shock.


Related previous pearls:

Norepinephrine or Dopamine ? ,
Dopamine-S and Dopamine-R patients ? ,
Renal dose Fenoldopam ? and
Renal Dose Norepinephrine !


References: click to get abstract/article

1. Vasopressor and inotropic support in septic shock: An evidence-based review Critical Care Medicine: Volume 32(11) Supplement November 2004 pp S455-S465
2. THE SAFETY OF DOPAMINE VERSUS NOREPINEPHRINE AS VASOPRESSOR THERAPY IN SEPTIC SHOCK - chest, 2005
3. Renal Dose Norepinephrine! - Chest. 2004;126:335-337
4. Renal Effects of Norepinephrine in Septic and Nonseptic Patients - Chest. 2004;126:534-539.
5. Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study - Critical Care Medicine. 34(3):589-597, March 2006