Intensive Care Medicine

, Volume 22, Issue 1, pp 65–70 | Cite as

Circulatory and diuretic effects of dopexamine infusion in low-birth-weight infants with respiratory failure

  • P. Kawczynski
  • A. Piotrowski
Neonatal and Pediatric Intensive Care

Abstract

Objective

To investigate the effects of infusion of dopexamine hydrochloride, a new synthetic catecholamine, on cardiopulmonary status and urine output in neonates with respiratory and circulatory failure.

Design

Prospective clinical study with each patient serving as his own control.

Setting

Intensive care unit (14 beds) in a 300-bed paediatric teaching hospital.

Patients

Seventeen neonates with low birth weight (LBW) requiring mechanical ventilation in the first 4 days of life, who initially had two of the following symptoms: hypotension, oliguria, metabolic acidosis with base deficit >10 and failure to respond to volume loading.

Interventions

Cardiopulmonary variables, diuresis and acid-base status were measured before and after volume loading, in patients who did not improve infusion of dopexamine was started at a dose of 2μg kg−1 min−1 which was titrated to achieve blood pressure, urine output, and base deficit in normal range. Observations were continued for a period of 5 h.

Measurements and results

Systolic blood pressure increased significantly after 3 h. of dopexamine infusion and remained elevated up to the end of the study period. Diastolic and mean blood pressure increased slightly (NS). Diuresis increased significantly from the 4th h of dopexamine infusion. Arterial blood pH increased significantly from baseline at 5 h after the start of dopexamine administration. There was also a significant imporovement in the PtcO2/PaO2 index.

Conclusion

In neonates with respiratory and circulatory failure, dopexamine increases blood pressure and improves arterial pH and urine output.

Key words

Neonate Dopexamine Blood pressure Urine output 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Cuevas L, Yeh TF, John EG, Cuevas D, Plides RS (1991) The effect of low-dose dopamine infusion on cardiopulmonary and renal status in premature newborns with respiratory distress syndrome. Am J Dis Child 145: 799–803Google Scholar
  2. 2.
    DiSessa TG, Leitner M, Ti CC, Gluck L, Coen R, Friedman WF (1981) The cardiovascular effects of dopmamine in the severely asphyxiated neonate. J Pediatr 99: 772–776Google Scholar
  3. 3.
    Gill AB, Weindling AM (1993) Randomised controlled trial of plasma protein fraction versus dopamine in hypotensive, very low birthweight infants. Arch Dis Child 69: 284–287Google Scholar
  4. 4.
    Greenough A, Emery EF (1993) Randomized trial comparing dopmaine and dobutamine in preterm infants. Eur J Pediatr 152: 925–927Google Scholar
  5. 5.
    Miall-Allen VM, Whitelaw AGL (1989) Response to dopamine and dobutamine in preterm infants of less than 30 weeks gestation. Crit Care Med 17: 1166–1169Google Scholar
  6. 6.
    Padbury JF, Agata Y, Baylen BG, Ludlow JK, Polk DH, Goldblatt E, Pescetti J (1986) Dopamine pharmacokinetics in critically ill newborn infants. J Pediatr 110: 293–298Google Scholar
  7. 7.
    Perez CA, Reimer JM, Schreiber MD, Warburton D, Gregory GA (1986) Effect of high-dose dopamine on urine output in newborn infants. Crit Care Med 14: 1045–1049Google Scholar
  8. 8.
    Seri I, Tulassay T, Kiszel J, Machay T, Csmor S (1984) Cardiovascular response to dopamine in hypotensive preterm neonates with severe hyaline membrane diseases. Eur J Pediatr 142: 3–9Google Scholar
  9. 9.
    Gill AB, Weindling AM (1992) Echocardiographic assessment of cardiac function in shocked very low birthweight infants. Arch Dis Child 68: 17–21Google Scholar
  10. 10.
    Emery EF, Greenough A (1993) Efficacy of low-dose dopamine infusion. Acta Paediatr 82: 430–432Google Scholar
  11. 11.
    Molloy WD, Dobson K, Girling L, Greenberg ID, Prewitt RM (1984) Effects of dopamine on cardiopulmonary function and left ventricular volumes in patients with acute respiratory failure. Am Rev Respir Dis 130: 396–399Google Scholar
  12. 12.
    Molloy DW, Ducas J, Dobson K, Girling L, Prewitt RM (1986) Hemodynamic management in clinical acute hypoxemic respiratory failure. Dopamine versus dobutamine. Chest 89: 636–640Google Scholar
  13. 13.
    Prewitt RM, McCarthy J, Wood LDH (1981) Treatment of acute low-pressure pulmonary edema in dogs. J Clin Invest 67: 409–418Google Scholar
  14. 14.
    Westman L, Jamberg PO (1986) Effects of dobutamine on renal function in normal man. Acta Anaethesiol Scand 30: 72–75Google Scholar
  15. 15.
    Rozé JC, Tohier C, Maingueneau C, Lefevre M, Mouzard A (1993) Response to dobutamine and dopamine in the hypotensive, very preterm infant. Arch Dis Child 69: 59–63Google Scholar
  16. 16.
    Brown RA, Dickson J, Farmer JB, Hall JC, Humphries RG, Ince F, O'Connor SE, Simpson WT, Smith GW (1985) Dopexamine: a novel agonist at peripheral dopamine and beta 2 adrenoceptors. Br J Pharmacol 85: 599–608Google Scholar
  17. 17.
    Magrini F, Foulds R, Roberts N, Macchi G, Mondadori C, Zanchetti A (1987) Human renovascular effects of dopexamine hydrochloride: a novel agonist of peripheral dopamine and beta 2 adrenoreceptors. Eur J Clin Pharmacol 32: 1–4Google Scholar
  18. 18.
    Smith GW, Hall JC, Farmer JB, Simpson WT (1987), The cardiovascular actions of dopexamine hydrochloride, an agonist at dopamine receptors and beta-2 adrenoceptors in the dog. J Pharm Pharmacol 39: 636–641Google Scholar
  19. 19.
    Jaski BE, Wijns W, Foulds R, Serruys PW (1986) The haemodynamic and myocardial effects of dopexamine: a new beta-2 adrenoceptor and dopaminergic agonist. Br J Clin Pharmacol 21: 393–400Google Scholar
  20. 20.
    Hunter DN, Gray H, Mudaliar Y, Morgan C, Evans TW (1989) The effects of dopexamine hydrochloride on cardiopulmonary haemodynamics following cardiopulmonary bypass surgery. Int J Cardiol 23: 365–371Google Scholar
  21. 21.
    Bayliss J, Thomas L, Poole-Wilson P (1987) Acute hemodynamic and neuroendocrine effects of dopexamine, a new vasodilator for the treatment of heart, failure: comparison with dobutamine, captopril and nitrate. J Cardiovasc Pharmacol 9: 551–554Google Scholar
  22. 22.
    Svensson G, Sjogren A, Erhardt L (1986) Short-term haemodynamic effects of dopexamine in patients with chronic congestive heart failure. Eur Heart J 7: 697–703Google Scholar
  23. 23.
    Baumann G, Gutting M, Pfafferott C, Ningel K, Klein G (1988) Comparison of acute haemodynamic effects of dopexamine hydrochloride, dobutamine and sodium nitroprusside in chronic heart failure. Eur Heart J 9: 503–512Google Scholar
  24. 24.
    Tan L-B, Littler WA, Murray, RG (1987) Beneficial haemodynamic effects of intravenous dopexamine in patients with low-output heart failure. J Cardiovasc Pharmacol 10: 280–286Google Scholar
  25. 25.
    Bodenham AR, Park GR (1988) Dopexamine hydrochloride, a novel drug with renal, vasodilator properties: two case studies. Intensive Care Med 14: 663–665Google Scholar
  26. 26.
    Olsen NV, Lund J, Jensen PF, Espersen K, Kanstrup I-L, Plum I, Leyssac PP (1993) Dopamine, Dobutamine, and Dopexamine. A comparison of renal effects in unanesthetized human volunteers. Anesthesiology 79: 685–694Google Scholar
  27. 27.
    Taylor BJ, Rogers BW, Sziszak TL, Sziszak TJ (1993) Effects of dopexamine on hemodynamics and oxygen consumption after beta blockade in lambs. Crit Care Med 21: 733–739Google Scholar
  28. 28.
    Versmold HT, Kitterman JA, Phibbs RH, Gregory GA, Tooley WH (1981) Aortic blood pressure during the first 12 hours of life in infants with birth weigth 610 to 4222 grams. Pediatrics 67: 607–613Google Scholar
  29. 29.
    Weindling AM (1989) Blood pressure monitoring in the newborn. Arch Dis Child 64: 444–447Google Scholar
  30. 30.
    Morley CJ (1986) The respiratory distress syndrome. In: Roberton NRC (ed) Textbook of neonatology. Churchill Livingstone, EdinburghGoogle Scholar
  31. 31.
    Lund N, de Asila RJ, Papadakos PJ, Thorborg PAJ (1992) Dopexamine hydrochloride in septicemia: effects on gut, liver and muscle oxygenation. Crit Care Med 20: S46Google Scholar
  32. 32.
    Dawson JR, Thompson DS, Signy M, Juul SM, Turnbull P, Jenkins BS, Webb-Peploe MM (1985) Acute haemodynamic and metabolic effects of dopexamine, a new dopaminergic receptor agonist, in patients with chronic heart failure. Br Heart J 54: 313–320Google Scholar
  33. 33.
    Svenson G, Strandberg L-E, Lindvall B, Erhardt L (1988) Haemodynamic response to dopexamine hydrochloride in postinfarction heart failure: lack of tolerance after continuous infusion. Br Heart J 60: 489–496Google Scholar
  34. 34.
    Bristow MR, Ginsburg R, Umans V, Fowler M, Minobe W, Rasmussen R, Zera P, Menlove R, Shah P, Jamieson S, Stinson EB (1986) Beta1 and beta2 adrenergic receptor subpopulations in nonfailing and failing human ventricular myocardium: coupling of both receptor subtypes to muscle contraction and selective beta1 receptor down-regulation in heart failure. Circ Res 59: 297–309Google Scholar
  35. 35.
    Baumann G, Felix SB, Filcek SAL (1990) Usefulness of dopexamine hydrochloride versus dobutamine in chronic congestive heart failure and effects on hemodynamics and urine output. Am J Cardiol 65: 748–754Google Scholar
  36. 36.
    Smith GW, O'Connor SE (1988) An introduction to the pharmacologic properties of Dopacard (dopexamine hydrochloride). Am J Cardiol 62: 9C-17CGoogle Scholar
  37. 37.
    Leier CV, Binkley PF, Carpenter J, Randolph PH, Unverferth DV (1988) Cardiovascular pharmacology of dopexamine in low-output congestive heart failure. Am J Cardiol 62: 94–99Google Scholar
  38. 38.
    Colardyn FC, Vandenbogaerde JF, Vogelaers DP, Verbeke JH (1989) Use of dopexamine hydrochloride in patients with septic shock. Crit Care Med 17: 999–1003Google Scholar
  39. 39.
    Tremper KK, Shoemaker WC (1981) Transcutaneous oxygen monitoring of critically ill adults, with and without low-flow shock. Crit Care Med 9: 706–709Google Scholar
  40. 40.
    Mitchell PD, Smith GW, Wells E, West PA (1987) Inhibition of Uptake1 by dopexamine hydrochloride (in vitro). Br J Pharmacol 92: 265–270Google Scholar
  41. 41.
    Jaski BE, Peters C (1988) Inotropic, vascular and neuroendocrine effects of dopexamine hydrochloride and comparison with dobutamine. Am J Cardiol 62: 63C-67CGoogle Scholar
  42. 42.
    Drummond WH, Gregory GA, Heymann MA, Phibbs RA (1981) The independent effects of hyperventilation, tolazoline and dopamine on infants with persistent pulmonary hypertension. J Pediatr 98: 603–611Google Scholar
  43. 43.
    Sinner JR, Boys RJ, Hunter S, Hey EN (1992) Pulmonary and systemic arterial pressure in hyaline membrane disease. Arch Dis Child 67: 366–373Google Scholar
  44. 44.
    Walther FJ, Benders MJ, Leyton JO (1993) Early changes in theneonatal circulatory transition J Pediatr 123: 625–632Google Scholar
  45. 45.
    Hemmer M, Suter PM (1979) Treatment of cardiac and renal effects of PEEP with dopamine in patients with acute respiratory failure. Anesthesiology 40: 399–403Google Scholar
  46. 46.
    Mousdale S, Clyburn PA, Mackie AM, Groves ND, Rosen M (1988) Comparison of the effects of dopamine, dobutamine and dopexamine upon renal blood flow: a study in normal, healty volunteers. Br J Clin Pharmacol 25: 555–560Google Scholar
  47. 47.
    Jaton T, Thonney M, Gouyon J-B, Guinard J-P (1992) Renal effects of dopamine and dopexamine in the newborn anesthetized rabbit. Life Sci 50: 195–202Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • P. Kawczynski
    • 1
  • A. Piotrowski
    • 1
  1. 1.Intensive Care Unit, Paediatric HospitalUniversity School of MedicineŁódzPoland

Personalised recommendations