Dopamine may be used as the first-line drug to increase blood pressure in septic shock. A person whose blood pressure increases is considered dopamine-sensitive, while a person whose blood pressure does not increase is considered dopamine-resistant.
Features of dopamine resistant septic shock - all of the following:
(1) persistent hypotension (systolic blood pressure < 90 mm Hg; Levy et al use a mean arterial pressure < 70 mm Hg))
(2) after adequate fluid replacement AND
(3) after infusion of dopamine 15-20 micrograms per kg per minute, with or without infusion of dobutamine
where:
• Fluid was given until the pulmonary wedge pressure was 10-12 mm Hg, or there was a marked decrease in PaO2.
• Dopamine increases blood pressure, improves myocardial performance and causes a mild increase in systemic vascular resistance.
• Dobutamine causes peripheral vasodilation and is used when there is a low cardiac output and high filling pressure.
Observations of Bollaert et al:
(1) 7 of 13 patients with dopamine-resistant septic shock died.
(2) Epinephrine may be able to increase blood pressure in patients who are dopamine resistant.
(3) An increasing concentration of lactate during the infusion of epinephrine is a poor prognostic sign, while survivors showed decreases in lactate levels.
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