Dopamine Use and Its Consequences in The Intensive Care Unit: a Cohort Study Utilizing the Japanese Intensive care Patient Database

Background: Dopamine is used to treat patients with shock in intensive care units (ICU) throughout the world, despite recent evidence against its use. Current practice patterns for the use of dopamine have not been reported.Methods: The Japanese Intensive Care PAtient Database (JIPAD), the largest intensive care database in Japan, was utilized. Inclusion criteria included: 1) age 18 years or older, 2) admitted to the ICU for reasons other than procedures, 3) ICU length of stay of 24 hours or more, and 4) treatment with either dopamine or noradrenaline within 24 hours of admission. The primary outcome was in-hospital mortality. Multivariable regression analysis was performed, followed by a pre-planned propensity score-matched analysis.Results: Of the 132,354 case records, 14594 records from 56 facilities were included in this analysis. Dopamine was administered to 4653 patients and noradrenaline to 11844. There was no statistically significant difference in facility characteristics between frequent dopamine users (N = 28) and infrequent users (N = 28). Patients receiving dopamine had more cardiovascular diagnosis codes (70% vs. 42%; p<0.01), more post-elective surgery status (60% vs. 31%), and lower APACHE III scores compared to patients given noradrenaline alone (70.7 vs. 83.0; p<0.01). Multivariable analysis showed an odds ratio for in-hospital mortality of 0.86 [95% CI: 0.71-1.04] in the dopamine <=5 μg/kg/min group, 1.50 [95% CI: 1.18-1.82] in the 5-15 μg/kg/min group, and 3.30 [95% CI: 1.19-9.20] in the >15 μg/kg/min group. In 1:1 propensity score matching for dopamine use (3322 pairs), there was no statistically significant difference for in-hospital mortality between the dopamine group and no dopamine group (13.0% vs. 12.0%, p=0.21), but ICU length of stay was significantly longer in the dopamine group (mean 7.4 days vs. 6.6 days, p<0.01).Conclusion: Dopamine is still widely used in Japan. The results of this study suggest detrimental effects of dopamine use specifically at a high dose, although there is no significant association with increased in-hospital mortality.Trial registration: Retrospectively registered upon approval of the Institutional Review Board and the administration office of JIPAD.

Miliaria crystallina in an intensive care patient

Miliaria crystallina is a benign skin condition that follows intense sweating due to excessive exposure to heat, hyperthermia, or humidity. Therefore, it is often observed in intensive care patients, who usually meet these conditions.