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

John W. Simmons, Kevin K. Chung, Evan M. Renz, Christopher E. White, Casey L. Cotant, Molly A. Tilley, Mark O. Hardin, John A. Jones, Lorne H. Blackbourne, Steven Wolf

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Abstract

Background: Fenoldopam 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.Methods: We 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.Results: Seventy-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).Conclusions: These 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.

Original languageEnglish (US)
Article number9
JournalBMC Anesthesiology
Volume10
DOIs
StatePublished - Jun 24 2010
Externally publishedYes

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Fenoldopam
Intensive Care Units
Retrospective Studies
Blood Pressure
Acute Kidney Injury
Urine
Critical Illness
Creatinine
Kidney
Emergency Treatment
Renal Replacement Therapy
Dopamine Agonists
Chi-Square Distribution
Serum
Burns
Resuscitation
Analysis of Variance
Randomized Controlled Trials

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Simmons, J. W., Chung, K. K., Renz, E. M., White, C. E., Cotant, C. L., Tilley, M. A., ... Wolf, S. (2010). Fenoldopam use in a burn intensive care unit: A retrospective study. BMC Anesthesiology, 10, [9]. https://doi.org/10.1186/1471-2253-10-9

Fenoldopam use in a burn intensive care unit : A retrospective study. / Simmons, John W.; Chung, Kevin K.; Renz, Evan M.; White, Christopher E.; Cotant, Casey L.; Tilley, Molly A.; Hardin, Mark O.; Jones, John A.; Blackbourne, Lorne H.; Wolf, Steven.

In: BMC Anesthesiology, Vol. 10, 9, 24.06.2010.

Research output: Contribution to journalArticle

Simmons, JW, Chung, KK, Renz, EM, White, CE, Cotant, CL, Tilley, MA, Hardin, MO, Jones, JA, Blackbourne, LH & Wolf, S 2010, 'Fenoldopam use in a burn intensive care unit: A retrospective study', BMC Anesthesiology, vol. 10, 9. https://doi.org/10.1186/1471-2253-10-9
Simmons JW, Chung KK, Renz EM, White CE, Cotant CL, Tilley MA et al. Fenoldopam use in a burn intensive care unit: A retrospective study. BMC Anesthesiology. 2010 Jun 24;10. 9. https://doi.org/10.1186/1471-2253-10-9
Simmons, John W. ; Chung, Kevin K. ; Renz, Evan M. ; White, Christopher E. ; Cotant, Casey L. ; Tilley, Molly A. ; Hardin, Mark O. ; Jones, John A. ; Blackbourne, Lorne H. ; Wolf, Steven. / Fenoldopam use in a burn intensive care unit : A retrospective study. In: BMC Anesthesiology. 2010 ; Vol. 10.
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T2 - A retrospective study

AU - Simmons, John W.

AU - Chung, Kevin K.

AU - Renz, Evan M.

AU - White, Christopher E.

AU - Cotant, Casey L.

AU - Tilley, Molly A.

AU - Hardin, Mark O.

AU - Jones, John A.

AU - Blackbourne, Lorne H.

AU - Wolf, Steven

PY - 2010/6/24

Y1 - 2010/6/24

N2 - Background: Fenoldopam 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.Methods: We 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.Results: Seventy-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).Conclusions: These 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.

AB - Background: Fenoldopam 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.Methods: We 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.Results: Seventy-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).Conclusions: These 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.

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