pro - pcics · “norepinephrine and dopamine centrally administered are the initial vasopressors...

Pro:

Dopamine is Evil and Should be

Banned from the Face of the Earth

Martina Steurer, MD MAS

December 2018

No disclosures

Beta-3,4-Dihydroxypenylethylamine

Barger G, Dale HH: Chemical structure and sympathomimetic action of amines.

J Physiol 1910; 41:19–59

Dopamine

D1 and D2 Beta-1 Alpha-1

Renal and splanchnic

perfusion

Cardiac output via

chronotropy and inotropy

Increase of

peripheral resistance

Hemodynamic Effects of Dopamine

Dose

Receptor

Effect

< 5 mcg/kg/min 5-15 mcg/kg/min >15 mcg/kg/min

The myth of renal protection

When compared to dobutamine, there was no difference in renal function or urine output in

142 children after heart surgeryWenstone R, Campbell JM, Booker PD, McKay R. Renal function after cardiopulmonary bypass in children:

comparison of dopamine with dobutamine. Br J Anaesth. 1991.

Two meta analyses do not show protection from renal dysfunction or improve in outcome

variables Kellum JA, M Decker J. Use of dopamine in acute renal failure: a meta-analysis. Crit Care Med. 2001.

Marik PE. Low-dose dopamine: a systemic review. Int Care Med. 2002.

The myth of renal protection

Random effects model of weighted mean difference (95% confidence interval) of the change in

serum creatinine in patients randomized to low- dose dopamine compared to control

Marik PE. Low-dose dopamine: a systemic review. Int Care Med. 2002.

Maybe even harmful to the gut

Dopamine may cause uncompensated increase in splanchnic oxygen requirements in septic

patientsMarik PE and Mohedin M. The contrasting effects of dopamine and norepinephrine on systemic and splanchnic

oxygen utilization in hyperdynamic sepsis. JAMA. 1994.

Dopamine does not increase splanchnic blood flow in the critically illMaynard ND, Bihari DJ, Dalton RN, Smithies MN, Mason RC. Increasing splanchnic blood flow in the critically III.

Chest. 1995.

Dopamine decreases gastric mucosal blood flow in septic patientsNevière R, Mathieu D, Chagnon JL, Lebleu N, Wattel F. The contrasting effects of dobutamine and dopamine on

gastric mucosal perfusion in septic patients. Am J Respir Crit Care Med. 1996.

D1 and D2 Beta-1 Alpha-1

Renal and splanchnic

perfusion

Cardiac output via

chronotropy and inotropy

Increase of

peripheral resistance

Hemodynamic Effects of Dopamine

Dose

Receptor

Effect

< 5 mcg/kg/min 5-15 mcg/kg/min >15 mcg/kg/min

Dobutamine NorepinephrineEpinephrine

Vasopressin

Milrinone

2008

2017

Surviving Sepsis Campaign

“Norepinephrine and dopamine centrally administered are the initial vasopressors of

choice”

“We recommend norepinephrine as the first- choice vasopressor“

Dopamine for sepsis or septic shock

2008

2017

Surviving Sepsis Campaign

“Norepinephrine and dopamine centrally administered are the initial vasopressors of

choice”

“We recommend norepinephrine as the first- choice vasopressor“

De Backer D, Aldecoa C, Njimi H, Vincent J-L. Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis. Crit Care Med 2012.



Epinephrine is more effective than dopamine in achieving resolution of fluid-

refractory hypotensive cold shock within the first hour of resuscitation and

improving organ functions.

Pediatric Evidence

Nov 2016

Other diabolic effects of Dopamine

Respiratory system Immune system Pituitary glandCNS


Respiratory effects

Reduces ventilatory response to hypoxia and

hypercapniaSabol SJ, Ward DS. Effect of dopamine on hypoxic-hypercapnic

interaction in humans. Anesthesia & Analgesia. 1987.

Slows respiratory rateWard DS, Bellville JW. Effect of intravenous dopamine on

hypercapnic ventilatory response in humans. J Appl Physiol Respir

Environ Exerc Physiol. 1983.

Glomus caroticum

Common carotid artery


Immunological effects


Immunological effects

D1 and D2 receptors

T-cell B-cell

Santambrogio L, Lipartiti M, Bruni A, Dal Toso R. Dopamine receptors on human T and B-lymphocytes. J Neuroimmunol. 1993.

Kouassi E, Li YS, Boukhris W, Millet I, Revillard JP. Opposite effects of catecholamines dopamine and norepinephrine on murine polyclonal B-cell

activation. Immunopharmacology. 1988

Devins SS, Miller A, Herndon BL, O’Toole L, Reisz G. Effects of dopamine on T-lymphocyte proliferative responses and serum prolactin concentrations

in critically ill patients. 1992.

Cytokine secretion Proliferation Ig secretion


CNS


Reward

Schizophrenia

Parkinson


CNS

Dopamine administration is associated with delirium in critically ill patients and in

patients after coronary artery bypass surgery - two retrospective observational studies

Sommer BR, Wise LC, Kraemer HC. Is dopamine administration possibly a risk factor for delirium? Crit Care Med.

2002.

Seyhan Yilmaz MD P, MD EA, Adem Ilkay Diken MD P, Adnan Yalcinkaya MD P, MD MEE, Kerim Cagli MD P.

Dopamine Administration is a Risk Factor for Delirium in Patients Undergoing Coronary Artery Bypass Surgery.

Heart, Lung and Circulation. 2016.

Blood brain barrier


Pituitary gland and endocrine effects



ProlactinTSH

Growth Hormone

Anterior pituitary lobePosterior pituitary lobe

Dopamine

T-cell proliferation



Suppressed pituitary function in 33 infants and children treated with dopamine

after cardiothoracic surgery for congenital heart diseaseVan den Berghe G, de Zegher F, Lauwers P. Dopamine suppresses pituitary function in infants and

children. Crit Care Med. 1994.

Review on dopamine and anterior pituitary functionVan den Berghe G, de Zegher F. Anterior pituitary function during critical illness and dopamine treatment.

Crit Care Med. 1996.

Dopamine is evil

Norepinephrine

Epinephrine

Thank you!

pro - pcics · “norepinephrine and dopamine centrally administered are the initial vasopressors...

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