How is dopamine used in the treatment of sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

A precursor of norepinephrine and epinephrine, dopamine has varying effects, according to the doses infused. At lower doses, it has a much greater effect on beta receptors; at higher doses, it has more alpha-receptor effects and increases peripheral vasoconstriction.

Dosages range from 2 to 20 µg/kg/min. A dosage lower than 5 µg/kg/min results in vasodilation of renal, mesenteric, and coronary beds. [11] At a dosage of 5-10 µg/kg/min, beta1 -adrenergic effects induce an increase in cardiac contractility and heart rate. At dosages of about 10 µg/kg/min, alpha-adrenergic effects lead to arterial vasoconstriction and elevation in blood pressure. [11]

Dopamine is often effective for restoring mean arterial pressure in patients with septic shock who remain hypotensive after volume resuscitation. The blood pressure increases primarily as a result of the drug’s inotropic effect, which is useful in patients who have concomitant reductions in cardiac function. However, as mentioned above, in a comparison of norepinephrine to dopamine for the management of arterial pressure in septic shock, failure of dopamine to reach mean arterial pressure targets occurred in 30% of the treatment arm, necessitating adding norepinephrine.

Dopamine may be particularly useful in the setting of cold shock, where peripheral vasoconstriction exists (cold extremities) and cardiac output is too low to maintain tissue perfusion. Undesirable effects include tachycardia, increased pulmonary shunting, the potential to decrease splanchnic perfusion, and an increase in pulmonary arterial wedge pressure (PAWP).

Low-dose (renal-dose) dopamine has been studied. Dopamine at a dosage of 2-3 µg/kg/min is known to initiate diuresis by increasing renal blood flow in healthy animals and volunteers; however, several well-designed clinical trials have not found such regimens to have any beneficial effects on renal blood flow and function in the setting of circulatory shock of any etiology.

Multiple studies also have not shown prophylactic or therapeutic low-dose dopamine administration to have any beneficial effect in patients with sepsis who are critically ill. In view of the real side effects of dopamine infusion, the use of renal-dose dopamine should be abandoned.


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