The effects of low-dose dopamine infusions on haemodynamic and renal parameters in patients with septic shock requiring treatment with noradrenaline.
OBJECTIVE
To investigate whether low-dose dopamine (LDD) has a significant effect on systemic haemodynamic variables and renal function when used in conjunction with high-dose noradrenaline in optimally volume-resuscitated patients with septic shock.


METHODS
A prospective clinical study in which each patient acted as his/her own control.


METHODS
Teaching hospital Intensive Care Unit.


METHODS
Twenty-one patients with septic shock treated with high-dose noradrenaline were studied, 17 patients completed the study.


METHODS
Fluid loading to an optimal left ventricular stroke work index (LVSWI) whilst on more noradrenaline than 10 mcg/min and dopamine of 2.5 mcg/kg per min. Three study periods each of 2 h with LDD present, withdrawn and restarted. During each period a complete haemodynamic profile and measurement of urine flow rate, creatinine clearance and sodium excretion was performed.


RESULTS
Removing and restarting LDD caused marked changes in cardiac index (CI, 17% fall, p < 0.01: 23% rise, p < 0.01), stroke volume (SV, 11% fall, p < 0.05: 14% rise, p < 0.05) and systolic blood pressure (SBP, 11% fall, p < 0.05: 14% rise, p < 0.05). Urine volume fell by 40% (p < 0.05) when dopamine was withdrawn. Significant reductions in sodium excretion (p < 0.05) and fractional sodium excretion (p < 0.05) also occurred on stopping LLD. Changes in creatinine clearance were not statistically significant.


CONCLUSIONS
Low-dose dopamine causes significant increases in SBP SV, cardiac output and urine flow during treatment with noradrenaline.
Magill Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.
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Juste
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Panikkar
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Soni
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000368:Aged; D003422:Critical Care / Q000379:methods; D004298:Dopamine / Q000008:administration & dosage / Q000494:pharmacology*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D009638:Norepinephrine / Q000627:therapeutic use*; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy*; D014554:Urination / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000316:Adrenergic alpha-Agonists; D014662:Vasoconstrictor Agents; D004298:Dopamine; D009638:Norepinephrine