Why the study?
Does dopamine improve renal function or survival compared to standard care or norepinephrine in critically-ill ICU patients?
Does dopamine improve renal function or survival compared to standard care or norepinephrine in critically-ill ICU patients?
The widespread use of dopamine in the ICU, particularly for renal prophylaxis or as a first-line vasopressor in septic shock, should be reassessed in favor of alternatives like norepinephrine.
Supports caution with prophylactic dopamine in septic shock; leaves open confirmatory RCTs on vasopressor choice.
Dopamine is frequently administered in the ICU to critically-ill patients. The widespread use of dopamine does not only involve states of distributive and cardiogenic (imminent) shock, but also prophylaxis for deterioration and/or improvement of kidney- and bowel perfusion. Although many studies have shown an increase of renal- and (in some studies) improvement of splanchnic circulation, well controlled studies have failed to demonstrate a better outcome with respect to renal function and/or survival of prophylactic dopamine administration. Furthermore, evidence exists that norepinephrine is more efficacious in fluid resuscitated septic shock patients to restore blood pressure than dopamine, without jeopardizing the renal function. It is concluded that the widespread use of dopamine in the ICU should be reassessed.
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Girbes et al. (1997) studied this question.
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