Hemodynamic support and the role of dopamine.

The armamentarium of the critical care nephrologist contains several vasoactive and inotropic drugs with powerful effects on the systemic circulation. The physiologically logical use of these drug can be life-saving and have important beneficial effects on renal function. Such drug use must absolutely not be based on a "fixed dosage," but must instead be goal-directed with the aim of achieving those physiological states associated with hemodynamic stability and adequate vital organ perfusion. The achievement and maintenance of these goals must be prompt and guided by appropriate invasive hemodynamic monitoring and may require frequent changes in dosage. When these measures are adhered to, renal protection and clinical success are a much more likely outcome than when stereotyped approaches are followed.