Fenoldopam use in a burn intensive care unit: a retrospective study

BMC Anesthesiology

Research Article

John W Simmons¹  Lorne H Blackbourne¹  Mark O Hardin¹  John A Jones¹  Christopher E White²  Steven E Wolf²  Evan M Renz³  Kevin K Chung⁴  Casey L Cotant⁵  Molly A Tilley⁵ 

[1] United States Army Institute of Surgical Research, 3400 Rawley E. Chambers Avenue, 78234, Fort Sam Houston, Texas, USA;United States Army Institute of Surgical Research, 3400 Rawley E. Chambers Avenue, 78234, Fort Sam Houston, Texas, USA;UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, 78229, San Antonio, Texas, USA;United States Army Institute of Surgical Research, 3400 Rawley E. Chambers Avenue, 78234, Fort Sam Houston, Texas, USA;UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, 78229, San Antonio, Texas, USA;Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, 20814, Bethesda, Maryland, USA;United States Army Institute of Surgical Research, 3400 Rawley E. Chambers Avenue, 78234, Fort Sam Houston, Texas, USA;Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, 20814, Bethesda, Maryland, USA;Wilford Hall Medical Center, 2200 Bergquist Drive, 78236, San Antonio, Texas, USA;

关键词: Mean Arterial Pressure;    Renal Replacement Therapy;    Acute Kidney Injury;    Renal Blood Flow;    Continuous Renal Replacement Therapy;   

DOI  :  10.1186/1471-2253-10-9

 received in 2010-02-27, accepted in 2010-06-24,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundFenoldopam mesylate is a highly selective dopamine-1 receptor agonist approved for the treatment of hypertensive emergencies that may have a role at low doses in preserving renal function in those at high risk for or with acute kidney injury (AKI). There is no data on low-dose fenoldopam in the burn population. The purpose of our study was to describe our use of low-dose fenoldopam (0.03-0.09 μg/kg/min) infusion in critically ill burn patients with AKI.MethodsWe performed a retrospective analysis of consecutive patients admitted to our burn intensive care unit (BICU) with severe burns from November 2005 through September 2008 who received low-dose fenoldopam. Data obtained included systolic blood pressure, serum creatinine, vasoactive medication use, urine output, and intravenous fluid. Patients on concomitant continuous renal replacement therapy were excluded. Modified inotrope score and vasopressor dependency index were calculated. One-way analysis of variance with repeated measures, Wilcoxson signed rank, and chi-square tests were used. Differences were deemed significant at p < 0.05.ResultsSeventy-seven patients were treated with low-dose fenoldopam out of 758 BICU admissions (10%). Twenty (26%) were AKI network (AKIN) stage 1, 14 (18%) were AKIN stage 2, 42 (55%) were AKIN stage 3, and 1 (1%) was AKIN stage 0. Serum creatinine improved over the first 24 hours and continued to improve through 48 hours (p < 0.05). There was an increase in systolic blood pressure in the first 24 hours that was sustained through 48 hours after initiation of fenoldopam (p < 0.05). Urine output increased after initiation of fenoldopam without an increase in intravenous fluid requirement (p < 0.05; p = NS). Modified inotrope score and vasopressor dependency index both decreased over 48 hours (p < 0.0001; p = 0.0012).ConclusionsThese findings suggest that renal function was preserved and that urine output improved without a decrease in systolic blood pressure, increase in vasoactive medication use, or an increase in resuscitation requirement in patients treated with low-dose fenoldopam. A randomized controlled trial is required to establish the efficacy of low-dose fenoldopam in critically ill burn patients with AKI.

【 授权许可】

CC BY   
© Simmons et al; licensee BioMed Central Ltd. 2010