Renal effect of dopamine, norepinephrine, epinephrine, or norepinephrine–dobutamine in septic shock
© Biomed central limited 2001
Published: 1 March 2002
To investigate the renal effect of dopamine, norepinephrine, epinephrine, or norepinephrine–dobutamine in septic shock.
A prospective clinical study in which each patient acted as his/her own control.
Teaching hospital Intensive Care Unit.
Twenty-two patients with septic shock completed the study.
Fluid loading to an optimal left ventricular stroke work index (LVSWI) whilst treated with dopamine, norepinephrine, epinephrine, or norepinephrine–dobutamine each in a randomized order, which was adjusted to maintain mean arterial pressure >80 mmHg for 2 hours. After each 2 hours, a complete hemodynamic parameters and measurement of urine flow rate, creatinine clearance and sodium excretion were performed.
Measurement and results
All patients fulfilled the therapy goals after being treated with all kinds of the drugs. No statistical differences were found for right atrial pressure (CVP), mean pulmonary arterial wedge pressure (PAWP), mean pulmonary arterial pressure (PAP), mean systemic arterial pressure (MAP) during dopamine, norepinephrine, epinephrine and norepinephrine–dobutamine infusions. Epinephrine induced a significant higher cardiac index (CI) compared with norepinephrine alone and norepinephrine–dobutamine (P < 0.05). Compared with other three groups, cretinine clearance increased significantly in norepinephrine–dobutamine (P < 0.05), but urine volume increased in dopamine group as compared with epinephrine group (P < 0.05).
Dopamine, norepinephrine, epinephrine, or norepinephrine–dobutamine could improve systemic hemodynamics in septic shock, but their renal effects were different, dopamine acted as a diuretic and did not improve creatinine clearance, norepinephrine–dobutamine improved creatinine clearance without a significant change in urine output, norepinephrine, epinephrine had no markedly renal effect.