CRITICAL CARE AND TRAUMA
Is There Still a Place for Dopamine in the Modern Intensive Care Unit?
Yves A. Debaveye, MD, and Greet H. Van den Berghe, MD PhD
Department of Intensive Care Medicine, Catholic University of Leuven,
Leuven, Belgium
Address correspondence and reprint requests to Greet Van den Berghe, MD,
PhD, Department of Intensive Care Medicine, Catholic University of
Leuven,
B-3000 Leuven, Belgium. Address e-mail to
[EMAIL PROTECTED]
For many years, dopamine was considered an essential drug in the
intensive
care unit (ICU) for its cardiovascular effects and, even more, for its
supposedly protective effects on renal function and splanchnic mucosal
perfusion. There is now ample scientific evidence that low dose dopamine
is
ineffective for prevention and treatment of acute renal failure and for
protection of the gut. Until recently, low-dose dopamine was considered
to
be relatively free of side effects. However, it is now clear that
low-dose
dopamine, besides not achieving the preset goal of organ protection, may
also be deleterious because it can induce renal failure in normo- and
hypovolemic patients. Furthermore, dopamine may cause harm by impairing
mucosal blood flow and by aggravating reduced gastric motility. Dopamine
also suppresses the secretion and function of anterior pituitary
hormones,
thereby aggravating catabolism and cellular immune dysfunction and
inducing
central hypothyroidism. In addition, dopamine blunts the ventilatory
drive,
increasing the risk of respiratory failure in patients who are being
weaned
from mechanical ventilation. We conclude that there is no longer a place
for
low-dose dopamine in the ICU and that, in view of its side effects,
Is There Still a Place for Dopamine in the Modern Intensive Care Unit?
Yves A. Debaveye, MD, and Greet H. Van den Berghe, MD PhD
Department of Intensive Care Medicine, Catholic University of Leuven,
Leuven, Belgium
Address correspondence and reprint requests to Greet Van den Berghe, MD,
PhD, Department of Intensive Care Medicine, Catholic University of
Leuven,
B-3000 Leuven, Belgium. Address e-mail to
[EMAIL PROTECTED]
For many years, dopamine was considered an essential drug in the
intensive
care unit (ICU) for its cardiovascular effects and, even more, for its
supposedly protective effects on renal function and splanchnic mucosal
perfusion. There is now ample scientific evidence that low dose dopamine
is
ineffective for prevention and treatment of acute renal failure and for
protection of the gut. Until recently, low-dose dopamine was considered
to
be relatively free of side effects. However, it is now clear that
low-dose
dopamine, besides not achieving the preset goal of organ protection, may
also be deleterious because it can induce renal failure in normo- and
hypovolemic patients. Furthermore, dopamine may cause harm by impairing
mucosal blood flow and by aggravating reduced gastric motility. Dopamine
also suppresses the secretion and function of anterior pituitary
hormones,
thereby aggravating catabolism and cellular immune dysfunction and
inducing
central hypothyroidism. In addition, dopamine blunts the ventilatory
drive,
increasing the risk of respiratory failure in patients who are being
weaned
from mechanical ventilation. We conclude that there is no longer a place
for
low-dose dopamine in the ICU and that, in view of its side effects,
its extended use as a vasopressor may also be questioned.
Vu dernierement sur ccm-l.
Laurence Braun
Catherine Bich <[EMAIL PROTECTED]> wrote:
Catherine Bich <[EMAIL PROTECTED]> wrote:
En cas de support avec vasopresseurs en cas de choc septique,votre premier choix est-il la dopa ou la norepinephrine?
C.
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