Do we need a dopaminergic agent in the management of the critically ill?

1. The stimulation of dopaminergic receptors is in principle attractive to increase urine and sodium excretion in patients with compromised renal blood flow. 2. However, a protective role of dopaminergic agents on renal function has not been well established. Most of the trials have been performed with dopamine, a substance which can have vasoconstrictive properties, even at relatively low doses in the critically ill patient. 3. Perhaps other dopaminergic agents without alpha-adrenergic effects such as dopexamine could be more advantageous. Randomized, prospective, controlled clinical studies should be performed to test the hypothesis that dopaminergic agents can reduce the incidence of acute tubular necrosis in critically ill patients.