The 52 in 52 Review: Comparison of Dopamine and Norepinephrine in the Treatment of Shock

 

Article Citation: De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779-89.

 

What We Already Know About the Topic: The recent 2016 Surviving Sepsis Campaign Guidelines continue a strong recommendation for norepinephrine as the first-line vasoactive agent in the treatment of septic shock. Furthermore, the use of dopamine is a weak recommendation in selected patients at low risk for tachyarrhythmias and bradycardia.1 Using low-dose dopamine for purported renal protection has a strong negative recommendation.

 

Why This Study Is Important: This study laid the groundwork for the recommendations for norepinephrine as the first line pressor in septic shock. It would later become the largest of the included studies in a meta-analysis by the same lead author, De Backer et al, in 2012 which found mortality and arrhythmia risks with dopamine.2

 

Brief Overview of the Study: The multicenter, randomized trial assigned 1,679 patients to either dopamine or norepinephrine and evaluated the primary outcome of rate of death at 28-days. Secondary endpoints included number of days without need for organ support and occurrence of adverse events.

 

Limitations: Open label norepinephrine was used after the maximum doses of norepinephrine or dopamine were used.

 

Take Home Points: In the treatment of shock, the use of either dopamine or norepinephrine showed similar 28-day mortality. However, the use of dopamine was associated with greater incidence of arrhythmias.

 

References:

 

  1. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;
  2. DeBacker D, Aldecoa C, Njimi H, et al. Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis. Crit Care Med. 2012;40(3):725-30.

 

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