The use of dopamine and norepinephrine in ICU patients with special reference to renal function

Dopamine is still a very popular drug, used extensively in the intensive care for its presumed salutary renal effects, with a presumed increase in especially renal blood flow and diuresis. Although the effect on renal blood flow are not always present, the routinely measured property of an increased diuresis is clinically apparent in the ICU. However, there is a lack of evidence that these effects influence favourably the outcome of critically ill patients, when dopamine is given 'routinely' at a low dose infusion rate. The data on the effects on splanchnic perfusion are ambiguous. With respect to its use in patients with septic shock, recent evidence strongly suggests that norepinephrine is more effective in restoring blood pressure. Furthermore, in contrast to what is still frequently believed, recent data give convincing evidence that norepinephrine improves renal function (GFR) in the clinical setting. Norepinephrine is therefore according to the authors a pharmacologically sound and safe choice in patients with septic shock after adequate fluid resuscitation.