Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study.
Sakr Y, Reinhart K, Vincent JL, Sprung CL, Moreno R, Ranieri VM, De Backer D, Payen D.
Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium.
Crit Care Med. 2006 Mar;34(3):589-97.
OBJECTIVE: The optimal adrenergic support in shock is controversial. We investigated whether dopamine administration influences the outcome from shock. DESIGN: Cohort, multiple-center, observational study. SETTING: One hundred and ninety-eight European intensive care units. PATIENTS: All adult patients admitted to a participating intensive care unit between May 1 and May 15, 2002. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were followed up until death, until hospital discharge, or for 60 days. Shock was defined as hemodynamic compromise necessitating the administration of vasopressor catecholamines. Of 3,147 patients, 1,058 (33.6%) had shock at any time; 462 (14.7%) had septic shock. The intensive care unit mortality rate for shock was 38.3% and 47.4% for septic shock. Of patients in shock, 375 (35.4%) received dopamine (dopamine group) and 683 (64.6%) never received dopamine. Age, gender, Simplified Acute Physiology Score II, and Sequential Organ Failure Assessment score were comparable between the two groups. The dopamine group had higher intensive care unit (42.9% vs. 35.7%, p=.02) and hospital (49.9% vs. 41.7%, p=.01) mortality rates. A Kaplan-Meier survival curve showed diminished 30 day-survival in the dopamine group (log rank=4.6, p=.032). In a multivariate analysis with intensive care unit outcome as the dependent factor, age, cancer, medical admissions, higher mean Sequential Organ Failure Assessment score, higher mean fluid balance, and dopamine administration were independent risk factors for intensive care unit mortality in patients with shock. CONCLUSIONS: This observational study suggests that dopamine administration may be associated with increased mortality rates in shock. There is a need for a prospective study comparing dopamine with other catecholamines in the management of circulatory shock.
同期的 Critical Care Medicine 中的编者按指出，大家好像对多巴胺的偏爱好像是社区医院的传统和对去甲的“惧怕”，并没有什么依据。“一点β ，一点 ɑ ，兴许管用”。（也就是我的万金油之说）。There is no rational evidence to support this, but one may argue that among community hospital physicians, there is a certain “fear” of norepinephrine and the belief that dopamine, “a little bit β and a little bit ɑ, as inotrope or vasopressor, may do the job.” 同时，该编者按再次强调了多巴胺对肾没有保护作用，反而增加肾氧耗。There is evidence that dopamine may increase renal oxygen consumption and may therefore jeopardize renal oxygen supply/demand balance. There is also ample evidence that the so-called renal dopamine does not change mortality, risk of renal failure, or need for extracorporeal renal replacement therapy ([24]). The evidence-based guidelines published in 2004 in this journal do not support the use of dopamine as renal protection or renal salvage agent ([27]).