In this episode, I’ll discuss how the use of dopamine for shock affects mortality rates.
Surviving Sepsis Guidelines do not list dopamine as one of the vasopressors to use for the treatment of septic shock, and other types of shock are usually treated with non-dopamine vasopressors as well due to the higher rate of ventricular arrhythmias associated with dopamine use.
However, dopamine is the only vasopressor available in a premixed, extended stability, ready-to-use form. This makes it likely to be included in code carts or more readily available than other vasopressors which can contribute to its selection. In addition, old habits can be hard to break and clinicians that are used to using dopamine because it was part of their training may continue using it out of habit.
To explore the consequences of dopamine use to treat patients with shock, a group of authors published a retrospective analysis of dopamine use based on data from the Japanese Intensive Care PAtient Database (JIPAD), the largest intensive care database in Japan.
Just under 15,000 patients who were in the ICU for at least 24 hours for shock were analyzed. The use of norepinephrine was about twice as prevalent as the use of dopamine, but there were still over 4600 patients who received dopamine in the analysis.
The group of patients who received dopamine tended to have more cardiovascular diagnoses, were more frequently post-surgical ICU admissions, and had lower APACHE III scores compared to patients given norepinephrine alone.
3 dosing categories for dopamine were examined which correspond to the breakpoints traditionally thought to have differing effects on various receptors: <5 mcg/kg/min, 5-15 mcg/kg/min, and >15 mcg/kg/min.
While the <5 mcg/kg/min group did not have any mortality difference, the 5-15 mcg/kg/min and the >15 mcg/kg/min groups had significantly higher mortality rates than the norepinephrine group. The odds ratio for mortality was 1.46 in the 5-15 mcg/kg/min group and 3.3 in the >15 mcg/kg/min group.
The authors concluded that the results of this study suggest detrimental effects of dopamine use on mortality rates, specifically at a high dose.
To access my free download area with 20 different resources to help you in your practice, go to pharmacyjoe.com/free.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
I think it’s necessary to consider some others things to interpret the results:
– It’s an observational study. As we are evaluating an intervention, are there any randomized control trials on this issue?
– Were those OR adjusted ? How do authors explain that dopamine patients do worse if they seem being less severely ill?