C. Ract et B. Vigue, Comparison of the cerebral effects of dopamine and norepinephrine in severely head-injured patients, INTEN CAR M, 27(1), 2001, pp. 101-106
Objective: To compare the cerebral effects of dopamine and norepinephrine a
fter severe head injury.
Design: Prospective, clinical study.
Setting: Surgical intensive care unit in a university hospital.
Patients: Nineteen patients with severe head-injuries already requiring vas
opressor therapy. Group 1: patients receiving dopamine (n = 9); group 2: pa
tients receiving norepinephrine (n = 10).
Intervention: Vasopressor therapy was switched from dopamine to norepinephr
ine in group 1 and from norepinephrine to dopamine in group 2, maintaining
the same mean arterial pressure (MAP).
Measurements and results: MAP, intracranial pressure (ICP), jugular venous
oxygen saturation (SjvO(2)), transcranial Doppler mean velocity in the midd
le cerebral artery (Vm), and transoesophagal Doppler aortic output (AO) wer
e evaluated under dopamine and norepinephrine. Means for each group were co
mpared with the paired Student's t-test. For the same MAP, ICP was signific
antly higher with dopamine than norepinephrine in both groups (respectively
, group 1: 26 +/- 11 vs 23 +/- 11 mmHg, P < 0.005; group 2: 39 +/- 13 vs 31
+/- 9 mmHg, P < 0.005). SjvO(2), Vm, and AO did not change significantly b
etween treatments. The ICP variation between treatments was not correlated
with the variation of any other measured parameter. The ICP variation betwe
en treatments was significantly higher in group 2 than group 1, which could
be explained by autoregulation mechanisms.
Conclusions: For the same MAP, ICP was significantly higher with dopamine t
han norepinephrine with no argument supporting an increase of cerebral bloo
d flow.