The Use of Dopamine and Norepinephrine in the ICU

Abstract

The discovery and recognition of the pronounced effects of dopamine on renal function more than thirty years ago by the group of Goldberg [1], has contributed to the current extensive use of dopamine in the intensive care unit (ICU). Particularly in low-dose, dopamine is administered in the ICU for its presumed renal protective effects. According to a recent audit of 93 ICUs in the UK, 50% of all patients at risk of developing renal failure were on low-dose dopamine. Forty-three ICUs had a protocol for the use of dopamine in patients at risk [2]. The properties ascribed to the infusion of low-dose dopamine, i.e. enhancement or preservation of renal blood flow with an increase in urine output, have made it attractive for internists, anesthesiologists, cardiologists and intensivists to prescribe dopamine to the critically ill patient. Additionally, dopamine is used to reverse the effects of positive pressure ventilation with positive end-expiratory pressure (PEEP), i.e., a decrease in cardiac output and renal blood flow with a concomitant fall in urine output. Also, the positive inotropic properties of dopamine reverse the negative inotropic effects of anesthetics. Since the (hourly) diuresis of the critically ill patient is considered a good marker of (peripheral) tissue perfusion, the diuretic properties of dopamine are valued by the clinician.