Comparison of systemic and renal effects of dopexamine and dopamine in norepinephrine-treated septic shock.
OBJECTIVE
Vasopressor-induced vasoconstriction may compromise renal and splanchnic blood flow in patients with septic shock, resulting in secondary organ failures. The authors compared the effects of the vasodilatatory agent dopexamine against renal-dose dopamine and placebo in patients with norepinephrine therapy and septic shock, using 24-hour serum creatinine clearance (C(crea)) as a major endpoint. The primary hypothesis to be tested was that dopexamine is more effective than dopamine and that dopamine shows better effects than placebo regarding organ failures and C(crea).


METHODS
A prospective, randomized, controlled, double-blinded study.


METHODS
Intensive care unit in a tertiary care university hospital.


METHODS
Sixty-one patients with septic shock defined according to established criteria.


METHODS
Patients received either dopexamine (2 microg/kg/min, n = 20), dopamine (3 microg/kg/min, n = 21), or placebo (n = 20).


RESULTS
The trial groups were similar in terms of baseline characteristics. The authors found no significant differences among the dopexamine, dopamine, and placebo groups with regard to a comprehensive number of renal function parameters including C(crea) and organ-failure scores. There was a significant increase in heart rate after dopexamine infusion; other hemodynamic parameters remained unchanged in the dopexamine group. In a post hoc analysis that included only patients with renal impairment at study inclusion (n = 28), patients who received dopamine showed significant improvements in C(crea) when compared with placebo. Dopexamine was not effective in this subgroup.


CONCLUSIONS
Dopexamine is no more effective than dopamine or placebo regarding renal function in patients with septic shock requiring norepinephrine. Both therapies do not influence organ-failure scores.
Schmoelz
Martin
M
Department of Anesthesiology, Ludwig-Maximilians University, Munich, Germany. martin.schmoelz@med.uni-muenchen.de
Schelling
Gustav
G
Dunker
Martin
M
Irlbeck
Michael
M
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003401:Creatine / Q000097:blood*; D004298:Dopamine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D018491:Dopamine Agonists / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000187:drug effects* / Q000502:physiology
D000316:Adrenergic alpha-Agonists; D002316:Cardiotonic Agents; D018491:Dopamine Agonists; C046318:dopexamine; D003401:Creatine; D004298:Dopamine; D009638:Norepinephrine