Is dopexamine superior to dopamine in the treatment of multiple trauma patients--a prospective, double-blind, randomised study.
BACKGROUND
The goal of this prospective, randomised, double-blind clinical trial study was to assess the effects of dopexamine hydrochloride on organ failure, inflammatory mediators and splanchnic oxygenation in blunt multiple trauma patients at high risk of multiple organ dysfunction syndrome (MODS).


METHODS
We performed a prospective randomised controlled trial on 30 consecutive blunt multiple trauma patients with ISS>or=16, age 18-60 years and initial blood pressure >or=120 mmHg initially admitted to our level I trauma centre. Patients were randomised to treatment with dopamine (n=15) or dopexamine (n=15) for 48 h after admission. Outcome in terms of mortality, MODS, splanchnic perfusion, complications, duration of stay was statistically analysed.


RESULTS
Dopexamine treatment was associated with impaired organ function and an increased duration of ventilation and ICU stay compared with patients who received dopamine treatment. The acute inflammatory response was increased in the Dopexamine group while a decreased pHi and MEGX formation and increased serum lactate levels were measured.


CONCLUSIONS
The indication to use dopexamine hydrochloride appears questionable. In the absence of an antiinflammatory effect, dopexamine demonstrated a disadvantageous ICU course in regards to the organ function and the duration of treatment. In addition, a decreased pHi and MEGX formation suggested a deterioration of splanchnic oxygenation.
Probst
Christian
C
Department of Trauma Surgery, Hannover Medical School, 30623 Hannover, Germany. probst.christian@mh-hannover.de
Hildebrand
Frank
F
van Griensven
Martijn
M
Baur
Hellmut
H
Mahlke
Lutz
L
Krettek
Christian
C
Pape
Hans-Christoph
HC
Grotz
Martin Rolf Wolfgang
MR
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D003422:Critical Care; D004298:Dopamine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism; D006801:Humans; D007902:Length of Stay; D008012:Lidocaine / Q000031:analogs & derivatives / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D009104:Multiple Trauma / Q000150:complications* / Q000378:metabolism / Q000401:mortality; D010101:Oxygen Consumption / Q000187:drug effects; D011446:Prospective Studies; D012121:Respiration, Artificial; D013152:Splanchnic Circulation / Q000187:drug effects; D015599:Trauma Severity Indices; D014665:Vasodilator Agents / Q000627:therapeutic use*; D014781:Viscera / Q000098:blood supply*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000378:metabolism / Q000401:mortality; D055815:Young Adult
D014665:Vasodilator Agents; C046318:dopexamine; D008012:Lidocaine; C001173:monoethylglycinexylidide; D004298:Dopamine