Treatment of Circulatory Shock With Dopamine
Studies on Survival
- Carlos E. Ruiz, MD, PhD;
- Max Harry Weil, MD, PhD;
- Richard W. Carlson, MD, PhD
- From the Shock Research Unit and the Institute of Critical Care Medicine, University of Southern California School of Medicine, Los Angeles; The Los Angeles County /University of Southern California Medical Center; and the Center for the Critically III, Hollywood Presbyterian Medical Center, Los Angeles.
Abstract
Therapeutic effects of dopamine hydrochloride on the peripheral and metabolic defects of shock were investigated in 34 patients with circulatory shock associated with myocardial infarction, bacteremia, or hypovolemia. Severity of the circulatory defect characterized by hypotension, reduced cardiac output, oliguria, and notably reduced skin (toe) temperature before treatment with dopamine was not directly related to survival. However, the arterial blood concentration of lactate before treatment with dopamine indicated the likelihood of survival. Patients who ultimately survived following treatment with dopamine had normal or only mildly elevated levels of arterial blood lactate before therapy. No patients with established shock states in whom perfusion failure was associated with substantial increases in the level of arterial blood lactate survived regardless of treatment with dopamine. Increases in toe temperature during dopamine treatment also emerged as a uniquely good indicator of favorable outcome during therapy.
(JAMA 242:165-168, 1979)
Footnotes
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Reprint requests to Institute of Critical Care Medicine, University of Southern California School of Medicine, 1300 N Vermont Ave, Los Angeles, CA 90027 (Dr Weil).
