Am. J. Respir. Crit. Care Med., Vol 154, No. 6, Dec 1996, 1664-1670.
Administration of low-dose dopamine to nonoliguric patients with sepsis syndrome does not raise intramucosal gastric pH nor improve creatinine clearance
D Olson, A Pohlman and JB Hall
Section of Pulmonary and Critical Care Medicine, University of Chicago Hospitals and Clinics, Illinois, USA.
Tissue hypoxia resulting from regional blood flow abnormalities and oxygen
extraction defects may underlie the pathogenesis of multiple system organ
failure (MSOF) in sepsis. Low-dose dopamine (LDD) is widely employed to
enhance splanchnic perfusion although data to support this approach are
lacking. We assessed the effect of LDD on surrogate markers of renal and
gastric perfusion. Sixteen nonoliguric mechanically ventilated patients
with sepsis syndrome received LDD (3 micrograms/kg/min) or placebo in a
double-blind crossover design experiment. Hemodynamics, gastric
intramucosal pH (pHi) urine volumes, urinary sodium excretion, and
cimetidine-corrected creatinine clearance were compared. Mortality for the
group was 63%. LDD caused a significant increase in urine volume (88 +/- 58
to 115 +/- 70 ml/h, p = 0.02, 95% confidence interval for change 4.7 to 49
ml/h), but no significant change in any other parameter. We conclude that
use of LDD results in diuresis but does not improve other markers of renal
or gut perfusion. These data do not support the use of LDD to reduce risk
of progression to MSOF in sepsis.
