Dopamine in heart failure and critical care

Dopamine is widely used in critical care to prevent renal function loss. Nevertheless sufficient evidence is still lacking of reduction in end points like mortality or renal replacement therapy. Dopaminergic treatment in chronic heart failure (CHF) has provided an example of unexpected adverse outcome. Pharmacoepidemiological data. Provide additional evidence, finding excess mortality in current ibopamine users (relative risk 2.03 in NYHA I-II CHF, 1.37 in NYHA III-IV), while no relation was found with antiarrhythmic use. In critical care, studies after infrarenal aortic surgery or during septic shock, respectively, failed to find, expected specific renal effects of dopamine. Effects on splanchnic flow mainly depend on baseline flow levels. The implications of recently documented unwanted effects of dopamine, like reduced ventilation and oxygenation during hypoxia, are discussed. In conclusion, controlled clinical trials remain mandatory to assess the overall clinical effects of dopamine in critical care.