Use of dopamine in the ICU. Hope, hype, belief and facts.

Dopamine is frequently administered in the ICU to critically-ill patients. The widespread use of dopamine does not only involve states of distributive and cardiogenic (imminent) shock, but also prophylaxis for deterioration and/or improvement of kidney- and bowel perfusion. Although many studies have shown an increase of renal- and (in some studies) improvement of splanchnic circulation, well controlled studies have failed to demonstrate a better outcome with respect to renal function and/or survival of prophylactic dopamine administration. Furthermore, evidence exists that norepinephrine is more efficacious in fluid resuscitated septic shock patients to restore blood pressure than dopamine, without jeopardizing the renal function. It is concluded that the widespread use of dopamine in the ICU should be reassessed.