Effects of dopamine and epinephrine infusions on renal hemodynamics in severe malaria and severe sepsis.
OBJECTIVE: To describe and compare the effects of dopamine and epinephrine in various doses on renal hemodynamics and oxygen transport in patients with severe malaria and severe sepsis. DESIGN: Prospective, controlled, crossover trial. SETTING: The intensive care unit of an infectious diseases hospi...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
2000
|
| _version_ | 1826274694876102656 |
|---|---|
| author | Day, N Phu, N Mai, N Bethell, D Chau, T Loc, P Chuong, L Sinh, D Solomon, T Haywood, G Hien, T White, N |
| author_facet | Day, N Phu, N Mai, N Bethell, D Chau, T Loc, P Chuong, L Sinh, D Solomon, T Haywood, G Hien, T White, N |
| author_sort | Day, N |
| collection | OXFORD |
| description | OBJECTIVE: To describe and compare the effects of dopamine and epinephrine in various doses on renal hemodynamics and oxygen transport in patients with severe malaria and severe sepsis. DESIGN: Prospective, controlled, crossover trial. SETTING: The intensive care unit of an infectious diseases hospital in Viet Nam. PATIENTS: Fourteen patients with severe falciparum malaria and five with severe sepsis. INTERVENTIONS: In an open, crossover design, we observed the effects on renal and systemic hemodynamics and oxygen transport of separate stepped infusions of epinephrine and dopamine. We measured renal blood flow (RBF) and cardiac output by the thermodilution method using fluoroscopically guided catheters. Creatinine clearance at each time point was calculated from the renal plasma flow and the renal arteriovenous difference in plasma creatinine. MEASUREMENTS AND MAIN RESULTS: Dopamine at a "renal" dose (2.5 microg/kg/min) was associated with a mean (95% confidence interval) fractional increase in the absolute renal blood flow index (RBFI) of 37% (13% to 61%) and in RBF as a fraction of cardiac output (RBF/CO) of 35% (10% to 59%; p = .007 and p = .014, respectively). The consequent 39% (14% to 64%) increase in renal oxygen supply (p = .002) was accompanied by a 32% (20% to 44%) decrease in the renal oxygen extraction ratio (p = .0003), leading to no net change in renal oxygen consumption. At higher doses (10 microg/kg/min), both RBF and RBF/CO were not significantly different from baseline values and decreased further as the dose was reduced again. There was no obvious explanation for this hysteresis. There was no change in renal oxygen consumption throughout the study. Because lactic acidosis developed, epinephrine was only given to eight of the 19 patients, and the full stepped epinephrine infusion was given to four patients. Epinephrine infusion was associated, both in absolute terms and when compared with dopamine, with a significant increase in renal vascular resistance (p = .0008 and .0005, respectively), a decrease in RBF/CO (p = .002 and .03), and a compensatory increase in the renal oxygen extraction ratio (p = .005 and .0001). RBFI and renal oxygen consumption remained constant throughout the epinephrine infusion profile. Neither epinephrine nor dopamine significantly affected creatinine clearance or urine output. Twelve patients (63%) were in established renal failure (plasma creatinine, >3 mg/dL) at the time of the study, although the presence or absence of renal failure did not significantly influence the effects of the study drugs. However, overall, the presence of renal failure was associated with a lower mean renal oxygen consumption, a lower mean renal oxygen consumption as a fraction of systemic oxygen consumption, and a higher mean renal vascular resistance. CONCLUSION: Although dopamine increased and epinephrine decreased fractional renal blood flow, there was no evidence that either drug produced either a beneficial or a deleterious effect on renal oxygen metabolism or function at any of the doses investigated. |
| first_indexed | 2024-03-06T22:47:22Z |
| format | Journal article |
| id | oxford-uuid:5da13b8f-f94a-436e-b0a2-16dc20f9b227 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T22:47:22Z |
| publishDate | 2000 |
| record_format | dspace |
| spelling | oxford-uuid:5da13b8f-f94a-436e-b0a2-16dc20f9b2272022-03-26T17:35:41ZEffects of dopamine and epinephrine infusions on renal hemodynamics in severe malaria and severe sepsis.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:5da13b8f-f94a-436e-b0a2-16dc20f9b227EnglishSymplectic Elements at Oxford2000Day, NPhu, NMai, NBethell, DChau, TLoc, PChuong, LSinh, DSolomon, THaywood, GHien, TWhite, NOBJECTIVE: To describe and compare the effects of dopamine and epinephrine in various doses on renal hemodynamics and oxygen transport in patients with severe malaria and severe sepsis. DESIGN: Prospective, controlled, crossover trial. SETTING: The intensive care unit of an infectious diseases hospital in Viet Nam. PATIENTS: Fourteen patients with severe falciparum malaria and five with severe sepsis. INTERVENTIONS: In an open, crossover design, we observed the effects on renal and systemic hemodynamics and oxygen transport of separate stepped infusions of epinephrine and dopamine. We measured renal blood flow (RBF) and cardiac output by the thermodilution method using fluoroscopically guided catheters. Creatinine clearance at each time point was calculated from the renal plasma flow and the renal arteriovenous difference in plasma creatinine. MEASUREMENTS AND MAIN RESULTS: Dopamine at a "renal" dose (2.5 microg/kg/min) was associated with a mean (95% confidence interval) fractional increase in the absolute renal blood flow index (RBFI) of 37% (13% to 61%) and in RBF as a fraction of cardiac output (RBF/CO) of 35% (10% to 59%; p = .007 and p = .014, respectively). The consequent 39% (14% to 64%) increase in renal oxygen supply (p = .002) was accompanied by a 32% (20% to 44%) decrease in the renal oxygen extraction ratio (p = .0003), leading to no net change in renal oxygen consumption. At higher doses (10 microg/kg/min), both RBF and RBF/CO were not significantly different from baseline values and decreased further as the dose was reduced again. There was no obvious explanation for this hysteresis. There was no change in renal oxygen consumption throughout the study. Because lactic acidosis developed, epinephrine was only given to eight of the 19 patients, and the full stepped epinephrine infusion was given to four patients. Epinephrine infusion was associated, both in absolute terms and when compared with dopamine, with a significant increase in renal vascular resistance (p = .0008 and .0005, respectively), a decrease in RBF/CO (p = .002 and .03), and a compensatory increase in the renal oxygen extraction ratio (p = .005 and .0001). RBFI and renal oxygen consumption remained constant throughout the epinephrine infusion profile. Neither epinephrine nor dopamine significantly affected creatinine clearance or urine output. Twelve patients (63%) were in established renal failure (plasma creatinine, >3 mg/dL) at the time of the study, although the presence or absence of renal failure did not significantly influence the effects of the study drugs. However, overall, the presence of renal failure was associated with a lower mean renal oxygen consumption, a lower mean renal oxygen consumption as a fraction of systemic oxygen consumption, and a higher mean renal vascular resistance. CONCLUSION: Although dopamine increased and epinephrine decreased fractional renal blood flow, there was no evidence that either drug produced either a beneficial or a deleterious effect on renal oxygen metabolism or function at any of the doses investigated. |
| spellingShingle | Day, N Phu, N Mai, N Bethell, D Chau, T Loc, P Chuong, L Sinh, D Solomon, T Haywood, G Hien, T White, N Effects of dopamine and epinephrine infusions on renal hemodynamics in severe malaria and severe sepsis. |
| title | Effects of dopamine and epinephrine infusions on renal hemodynamics in severe malaria and severe sepsis. |
| title_full | Effects of dopamine and epinephrine infusions on renal hemodynamics in severe malaria and severe sepsis. |
| title_fullStr | Effects of dopamine and epinephrine infusions on renal hemodynamics in severe malaria and severe sepsis. |
| title_full_unstemmed | Effects of dopamine and epinephrine infusions on renal hemodynamics in severe malaria and severe sepsis. |
| title_short | Effects of dopamine and epinephrine infusions on renal hemodynamics in severe malaria and severe sepsis. |
| title_sort | effects of dopamine and epinephrine infusions on renal hemodynamics in severe malaria and severe sepsis |
| work_keys_str_mv | AT dayn effectsofdopamineandepinephrineinfusionsonrenalhemodynamicsinseveremalariaandseveresepsis AT phun effectsofdopamineandepinephrineinfusionsonrenalhemodynamicsinseveremalariaandseveresepsis AT main effectsofdopamineandepinephrineinfusionsonrenalhemodynamicsinseveremalariaandseveresepsis AT bethelld effectsofdopamineandepinephrineinfusionsonrenalhemodynamicsinseveremalariaandseveresepsis AT chaut effectsofdopamineandepinephrineinfusionsonrenalhemodynamicsinseveremalariaandseveresepsis AT locp effectsofdopamineandepinephrineinfusionsonrenalhemodynamicsinseveremalariaandseveresepsis AT chuongl effectsofdopamineandepinephrineinfusionsonrenalhemodynamicsinseveremalariaandseveresepsis AT sinhd effectsofdopamineandepinephrineinfusionsonrenalhemodynamicsinseveremalariaandseveresepsis AT solomont effectsofdopamineandepinephrineinfusionsonrenalhemodynamicsinseveremalariaandseveresepsis AT haywoodg effectsofdopamineandepinephrineinfusionsonrenalhemodynamicsinseveremalariaandseveresepsis AT hient effectsofdopamineandepinephrineinfusionsonrenalhemodynamicsinseveremalariaandseveresepsis AT whiten effectsofdopamineandepinephrineinfusionsonrenalhemodynamicsinseveremalariaandseveresepsis |