In Reply:—

Information concerning the use of catecholamines continues to be confusing and conflicting. A recent study by Ichai et al.  1showed that dopamine, in doses of 3-, 7-, and 12-μg · kg−1· min−1, increased creatinine clearance in a group of critically ill patients, whereas similar doses of dobutamine had no effect on this parameter of renal function. These data directly contradict a previous study performed by Duke et al.  25 yr previously. These conflicting results, combined with information such as the data by Woehlck et al.  further substantiate the fact that plasma concentrations, clinical effects, and outcomes are very unpredictable with catecholamines. It is my hope that we are developing a standard of care concerning the use of catecholamines in the intensive care unit: these medications should be titrated to a specific desired effect rather than being used in “standard” doses for unclear therapeutic endpoints.

Ichai C, Soubielle J, Carles M, Giunti C, Grimaud D: Comparison of the renal effects of low to high doses of dopamine and dobutamine in critically ill patients: A single-blind randomized study. Crit Care Med 2000; 28: 921–8
Duke GJ, Briedis JH, Weaver RA: Renal support in critically ill patients: Low-dose dopamine or low-dose dobutamine? Crit Care Med 1994; 22: 1919–25