Bad medicine: low-dose dopamine in the ICU.
Low-dose dopamine administration (ie, doses < 5 microg/kg/min) has been advocated for 30 years as therapy in oliguric patients on the basis of its action on dopaminergic renal receptors. Recently, a large, multicenter, randomized, controlled trial has demonstrated that low-dose dopamine administered to critically ill patients who are at risk of renal failure does not confer clinically significant protection from renal dysfunction. In this review, we present the best evidence and summarize the effects of low-dose dopamine infusion in critically ill patients. We review the history and physiology of low-dose dopamine administration and discuss the reasons why dopamine is not clinically effective in the critically ill. In addition to the lack of renal efficacy, we present evidence that low-dose dopamine administration worsens splanchnic oxygenation, impairs GI function, impairs the endocrine and immunologic systems, and blunts ventilatory drive. We conclude that there is no justification for the use of low-dose dopamine administration in the critically ill.
Holmes
Cheryl L
CL
University of British Columbia, McDonald Research Laboratories, Vancouver, Canada.
Walley
Keith R
KR
D000818:Animals; D003404:Creatinine / Q000097:blood; D003422:Critical Care; D016638:Critical Illness; D004231:Diuresis / Q000187:drug effects; D004298:Dopamine / Q000008:administration & dosage*; D006801:Humans; D007362:Intensive Care Units; D007668:Kidney / Q000187:drug effects*; D009846:Oliguria / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000188:drug therapy*; D013152:Splanchnic Circulation / Q000187:drug effects; D016896:Treatment Outcome
D003404:Creatinine; D004298:Dopamine