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(Circulation. 1998;98:97-99.)
© 1998 American Heart Association, Inc.

Editorials

Low-Dose Dopamine and Oxygen Transport by the Lung

Robert L. Johnson, Jr, MD

From the Pulmonary and Critical Care Division, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas.

Correspondence to Robert L. Johnson, Jr, MD, Pulmonary and Critical Care Division, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75235-9034. E-mail rjohn2@mednet.swmed.edu

Key Words: Editorials • lung • ventilation • hypoxia • chemoreceptors • / mismatch

Dopamine is an endogenous catecholamine that preferentially reduces renal vascular resistance and increases glomerular filtration rate, urine flow, and solute excretion in normal subjects.¹ In contrast to norepinephrine, it increases cardiac output and aortic pressure without raising systemic vascular resistance (Table) and increases rather than decreases renal blood flow. Hence, dopamine was suggested as a potentially valuable pharmacological agent for treatment of cardiogenic and septic shock,^{2 3} particularly in patients who were oliguric. Even at low doses (ie, <5 µg · kg^-1 · min^-1), at which hemodynamic effects are relatively small, it raises glomerular filtration and causes modest diuresis in normal subjects that might protect against acute renal failure in oliguric patients who are in shock or heart failure.^{4 5 6 7} The synthetic catecholamine dobutamine was introduced later and had many features similar to those of dopamine but without preferential renal vasodilation.⁸ However, at high infusion rates, dobutamine enhances cardiac output, stroke index, and O₂ transport more effectively than dopamine,⁹ and it also minimizes afterload on the left ventricle. Dobutamine now is more often used for hemodynamic support in heart failure or cardiogenic shock, although the 2 drugs are sometimes used together for their complementary effects. Low-dose or so called "renal-dose" dopamine, however, has become widely used in intensive care units for its presumed protective effect on renal function in patients undergoing major surgical procedures, patients with refractory heart failure, and patients with cardiorespiratory failure who are receiving ventilatory support. In these settings, it is often considered to be relatively free . . . [Full Text of this Article]

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