Administration of low-dose dopamine to nonoliguric patients with sepsis syndrome does not raise intramucosal gastric pH nor improve creatinine clearance.
Tissue hypoxia resulting from regional blood flow abnormalities and oxygen extraction defects may underlie the pathogenesis of multiple system organ failure (MSOF) in sepsis. Low-dose dopamine (LDD) is widely employed to enhance splanchnic perfusion although data to support this approach are lacking. We assessed the effect of LDD on surrogate markers of renal and gastric perfusion. Sixteen nonoliguric mechanically ventilated patients with sepsis syndrome received LDD (3 micrograms/kg/min) or placebo in a double-blind crossover design experiment. Hemodynamics, gastric intramucosal pH (pHi) urine volumes, urinary sodium excretion, and cimetidine-corrected creatinine clearance were compared. Mortality for the group was 63%. LDD caused a significant increase in urine volume (88 +/- 58 to 115 +/- 70 ml/h, p = 0.02, 95% confidence interval for change 4.7 to 49 ml/h), but no significant change in any other parameter. We conclude that use of LDD results in diuresis but does not improve other markers of renal or gut perfusion. These data do not support the use of LDD to reduce risk of progression to MSOF in sepsis.
Olson
D
D
Section of Pulmonary and Critical Care Medicine, University of Chicago Hospitals and Clinics, Illinois, USA.
Pohlman
A
A
Hall
J B
JB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D002927:Cimetidine / Q000008:administration & dosage; D003404:Creatinine / Q000378:metabolism*; D018592:Cross-Over Studies; D004231:Diuresis / Q000187:drug effects; D004298:Dopamine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012964:Sodium / Q000652:urine; D013152:Splanchnic Circulation / Q000187:drug effects; D018746:Systemic Inflammatory Response Syndrome / Q000188:drug therapy / Q000378:metabolism* / Q000503:physiopathology
D000897:Anti-Ulcer Agents; D002927:Cimetidine; D012964:Sodium; D003404:Creatinine; D004298:Dopamine