What is the role of dopamine in the management of multiple organ dysfunction syndrome (MODS) in sepsis?

Updated: Jan 27, 2020
  • Author: Ali H Al-Khafaji, 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, depending on the dose administered. A dose lower than 5 µg/kg/min results in vasodilation of renal, mesenteric, and coronary beds. At a dose of 5-10 µg/kg/min, beta1 -adrenergic effects induce an increase in cardiac contractility and heart rate. At doses of about 10 µg/kg/min, alpha-adrenergic effects lead to arterial vasoconstriction and an increase in blood pressure.

Dopamine is only partially effective in increasing MAP in patients who are hypotensive with septic shock after volume resuscitation. The blood pressure increases primarily as a result of an inotropic effect, which is useful in patients who have concomitant reduced cardiac function. The undesirable effects are tachycardia, increased pulmonary shunting, potentially decreased splanchnic perfusion, and increased PAOP.

Renal-dose dopamine

In healthy volunteers, infusion of dopamine at low doses (0.5-2 mg/kg/min) increases both renal blood flow and the glomerular filtration rate by selective stimulation of renal dopaminergic receptors. However, “beneficial” effects of such renal-dose dopamine in sepsis are unsubstantiated. Multiple studies have not demonstrated a beneficial effect with prophylactic or therapeutic low-dose dopamine administration in patients who are critically ill.

Administering low-dose dopamine does not protect the patient from developing acute renal failure, and there is no evidence that it preserves mesenteric profusion. Consequently, routine use of this practice is not recommended. Aggressively resuscitating patients with septic shock, maintaining adequate perfusion pressure, and avoiding excessive vasoconstriction are effective measures for protecting the kidneys.


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