From the Guidelines
Dopamine drip is preferred over norepinephrine or dobutamine in specific clinical scenarios, such as patients with low risk of tachyarrhythmias and absolute or relative bradycardia, as suggested by the Surviving Sepsis Campaign guidelines 1.
Clinical Scenarios for Dopamine Use
- Patients with symptomatic bradycardia who are awaiting definitive treatment like pacemaker placement, as it provides chronotropic support at low doses (2-5 mcg/kg/min)
- Hypotensive patients with renal insufficiency, as low-dose dopamine (1-3 mcg/kg/min) can improve renal blood flow and urine output
- Cardiogenic shock with both hypotension and bradycardia, dopamine may be advantageous as it increases heart rate, contractility, and blood pressure
Dosing and Effects of Dopamine
- The typical dosing range for dopamine is 1-20 mcg/kg/min, titrated to effect
- At low doses (1-5 mcg/kg/min), dopamine primarily affects dopaminergic receptors improving renal perfusion
- At intermediate doses (5-10 mcg/kg/min), it has more beta-adrenergic effects increasing cardiac output
- At higher doses (>10 mcg/kg/min), alpha-adrenergic effects predominate causing vasoconstriction
Limitations of Dopamine
- Dopamine has largely fallen out of favor as a first-line vasopressor in septic shock and most forms of distributive shock, where norepinephrine is preferred due to more predictable effects and potentially fewer adverse outcomes, as noted in the Surviving Sepsis Campaign guidelines 1 and a global perspective on vasoactive agents in shock 1
- The use of dopamine as an alternative vasopressor agent to norepinephrine should be reserved for highly selected patients, as suggested by the guidelines 1 and supported by a study on the management of intra-abdominal infections 1
From the Research
Situations where Dopamine Drip is Preferred
- In certain cases, dopamine may be preferred over norepinephrine or dobutamine due to its ability to improve splanchnic flow mainly by increasing cardiac output 2.
- Dopamine can be used to improve kidney- and bowel perfusion, although its use as a prophylactic measure has been questioned due to lack of evidence showing improved outcomes 3.
Comparison with Norepinephrine
- Norepinephrine is often preferred over dopamine in fluid-resuscitated septic shock patients to restore blood pressure without jeopardizing renal function 3, 4.
- Norepinephrine may be preferred as a first-line therapy for a broad range of shock states, including septic shock 4.
Comparison with Dobutamine
- Dobutamine is often used as an inotrope agent to improve cardiac output and may be preferred over dopamine in certain situations 5, 2.
- Dobutamine can improve oxygen delivery and may improve mesenteric blood flow, making it a suitable option for patients with cardiogenic shock 5, 2.
Specific Situations
- In horses, dobutamine has been shown to improve systemic and peripheral hemodynamics, while dopamine decreased mean arterial pressure and peripheral perfusion 6.
- In patients with cardiogenic shock, dobutamine may be preferred over dopamine due to its ability to improve cardiac output and oxygen delivery 5.