Patel GP, Grahe JS, Sperry M, Singla S, Elpern E, Lateef O, Balk RA.; Shock. 2009 Oct 21.
BACKGROUND:: The optimum septic shock vasopressor support strategy is currently debated. This study was performed to evaluate the efficacy and safety of norepinephrine and dopamine as the initial vasopressor in septic shock patients who were managed with a specific treatment protocol.
METHODS:: Prospective, randomized, open-label, clinical trial in a medical intensive care unit comparing dopamine to norepinephrine as the initial vasopressor in fluid resuscitated 252 adult patients with septic shock. If the maximum dose of the initial vasopressor was unable to maintain the hemodynamic goal, then fixed dose vasopressin was added to each regimen. If additional vasopressor support was needed to achieve the hemodynamic goal, then phenylephrine was added.
RESULTS:: The primary efficacy endpoint was all cause 28-day mortality. Secondary endpoints included organ dysfunction, hospital and ICU length of stay, and safety (primarily occurrence of arrhythmias). The 28-day mortality rate was 50% (67/134) with dopamine as the initial vasopressor compared to 43% (51/118) for norepinephrine treatment (p=0.282). There was a significantly greater incidence of sinus tachycardia with dopamine [27.5% (33/120)] than norepinephrine [5.3% (7/132)] and arrhythmias noted with dopamine treatment [23.3% (18/120)] compared to norepinephrine treatment [5.3% (7/132)] (p<0.0001), respectively. Logistic regression analysis identified APACHE II score (p < 0.0001) and arrhythmia (p < 0.015) as significant predictors of outcome.
CONCLUSION:: In this protocol directed vasopressor support strategy for septic shock, dopamine and norepinephrine were equally effective as initial agents as judged by 28-day mortality rates. However, there were significantly more cardiac arrhythmias with dopamine treatment. Patients receiving dopamine should be monitored for the development of cardiac arrhythmias.
Weblink here