PMID- 15190961
OWN - NLM
STAT- MEDLINE
DCOM- 20040625
LR  - 20190706
IS  - 0090-3493 (Print)
IS  - 0090-3493 (Linking)
VI  - 32
IP  - 5
DP  - 2004 May
TI  - Renal, but not systemic, hemodynamic effects of dopamine are influenced by the 
      severity of congestive heart failure.
PG  - 1125-9
AB  - OBJECTIVE: To determine whether the short-term systemic and renal hemodynamic 
      response to dopamine is influenced by clinical severity of congestive heart 
      failure. DESIGN: Effects of increasing doses of dopamine were assessed in 
      patients consecutively admitted for acutely decompensated congestive heart 
      failure. SETTING: Intensive care unit. PATIENTS: We enrolled 16 congestive heart 
      failure patients stratified by clinical severity (New York Heart Association 
      [NYHA] class III, n = 8; NYHA class IV, n = 8) and two additional NYHA class III 
      patients as controls. INTERVENTIONS: Measurements were carried out throughout 
      five 20-min experimental periods: baseline, dopamine infusion at 2, 4, and 6 
      microg x kg(-1) x min(-1), and recovery. Controls received a similar amount of 
      saline. MEASUREMENTS AND MAIN RESULTS: Systemic and renal hemodynamics were 
      determined respectively by right cardiac catheterization and radioisotopes 
      (iodine 131-labeled hippuran and iodine 125-labeled iothalamate clearance). The 
      peak increase in heart rate and cardiac index occurred at a dopamine dose of 4-6 
      microg x kg(-1) x min(-1). The dose-response relation was similar in NYHA classes 
      III and IV. Improvement in effective renal plasma flow and glomerular filtration 
      rate, peaking at 4 microg x kg(-1) x min(-1), was more rapid and marked in NYHA 
      class III than class IV patients, in whom the renal fraction of cardiac output 
      failed to increase. The systemic and renal effects of dopamine were independent 
      of age. No change occurred in controls. CONCLUSIONS: The dose of dopamine 
      producing an optimal improvement of systemic and renal hemodynamics in congestive 
      heart failure is higher than usually reported. A greater clinical severity of 
      congestive heart failure impairs the renal effects of dopamine, probably through 
      a selective loss in renal vasodilating capacity.
FAU - Ungar, Andrea
AU  - Ungar A
AD  - Department of Critical Care Medicine and Surgery, Unit of Gerontology and 
      Geriatric Medicine, University of Florence and Azienda Ospedaliera Careggi, 
      Florence, Italy.
FAU - Fumagalli, Stefano
AU  - Fumagalli S
FAU - Marini, Maurizio
AU  - Marini M
FAU - Di Serio, Claudia
AU  - Di Serio C
FAU - Tarantini, Francesca
AU  - Tarantini F
FAU - Boncinelli, Lorenzo
AU  - Boncinelli L
FAU - Baldereschi, Giorgio
AU  - Baldereschi G
FAU - Valoti, Paolo
AU  - Valoti P
FAU - La Cava, Giuseppe
AU  - La Cava G
FAU - Olianti, Catia
AU  - Olianti C
FAU - Masotti, Giulio
AU  - Masotti G
FAU - Marchionni, Niccolo
AU  - Marchionni N
LA  - eng
PT  - Clinical Trial
PT  - Controlled Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Crit Care Med
JT  - Critical care medicine
JID - 0355501
RN  - 0 (Cardiotonic Agents)
RN  - VTD58H1Z2X (Dopamine)
SB  - IM
CIN - Crit Care Med. 2004 May;32(5):1228-9. PMID: 15190980
MH  - Acute Disease
MH  - Aged
MH  - Blood Flow Velocity/drug effects
MH  - Cardiac Output/drug effects
MH  - Cardiotonic Agents/pharmacology/*therapeutic use
MH  - Critical Care
MH  - Dopamine/pharmacology/*therapeutic use
MH  - Dose-Response Relationship, Drug
MH  - Drug Monitoring
MH  - Female
MH  - Glomerular Filtration Rate/drug effects
MH  - *Heart Failure/classification/drug therapy/physiopathology
MH  - Heart Rate/drug effects
MH  - Hemodynamics/*drug effects
MH  - Humans
MH  - Infusions, Intravenous
MH  - Linear Models
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Wedge Pressure/drug effects
MH  - Renal Circulation/*drug effects
MH  - *Severity of Illness Index
MH  - Treatment Outcome
EDAT- 2004/06/12 05:00
MHDA- 2004/06/26 05:00
CRDT- 2004/06/12 05:00
PHST- 2004/06/12 05:00 [pubmed]
PHST- 2004/06/26 05:00 [medline]
PHST- 2004/06/12 05:00 [entrez]
AID - 10.1097/01.ccm.0000124871.58281.d1 [doi]
PST - ppublish
SO  - Crit Care Med. 2004 May;32(5):1125-9. doi: 10.1097/01.ccm.0000124871.58281.d1.