Continuing the vasoactive meds week, we will talk about dopamine. It is a precursor of norepinephrine, inducing its release. There are dopamine receptors in the renal, splanchnic, coronary and cerebral vascular beds; stimulation of these receptors cause vasodilation. #critcare
Again, since our historical "nerdiness" was so well received, this is one of the first papers that talked about dopamin in shock: pubmed.ncbi.nlm.nih.gov/1563/#:~:text=…
And this is their conclusion:"Because dopamine increases myocardial contractility, selectively redistributes perfusion to essential viscera and allows a pharmacologic titration of effect, it is a logical first-choice catecholamine for treatment of shock and refractory HF."
How far we've come, huh? Since then, Dopamine has been named the "silent killer" in shock.
ncbi.nlm.nih.gov/pmc/articles/P…
ncbi.nlm.nih.gov/pmc/articles/P…
And in 2010, it was not shown to be a "killer", but it came with a multitude of side effects when used to treat various types of shock and compared to norepinephrine.
nejm.org/doi/full/10.10…
nejm.org/doi/full/10.10…
To give dopamine some credit, it was found to be non-inferior to transcutaneous pacing in unstable bradycardia unresponsive to atropine.
ahajournals.org/doi/epub/10.11…
ahajournals.org/doi/epub/10.11…
In conclusion, dopamine is a no go for shock, ok for unstable bradycardia unresponsive to atropine and good for the brain. 😉 #chestcritcare #critcare #pccm #shock
