Norepineprhine vs Dopamine : The debate
I found this abstract while reading Critical Care forum
Dopamine versus norepinephrine in septic shock: a meta-analysis
S Shenoy1, A Ganesh1, A Rishi1, V Doshi1, S Lankala1, J Molnar1,
1. Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA;
2. Memorial University of Newfoundland, St John’s, Canada
Critical Care 2011, 15(Suppl 1):P89 (doi: 10.1186/cc9509)
Introduction The aim of this meta-analysis is to compare the changes
in hemodynamic parameters among patients with septic shock who
have received either of the two agents in their management and try to
deduce the superiority of one over the other.
Methods A total of 880 articles were identifi ed by a computerized search using MEDLINE, OVID and the Cochrane Central Register of Controlled Trials, of which six randomised controlled studies were included in the study. Observational data, retrospective studies or animal-based studies were excluded. Main outcome measures evaluated were the changes from the baseline in heart rate, mean arterial pressure, oxygen delivery index, oxygen extraction, systemic vascular resistance index (SVRI), cardiac index (CI), central venous pressure, blood lactate levels, urine output, mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure, right ventricular ejection fraction (RVEF), arrhythmias and 28-day mortality rates.
The statistical analysis was performed using Comprehensive Meta-Analysis software.
Results No signifi cant difference was found in mortality between
the two groups (RR = 1.067, CI = 0.984 to 1.157, P = 0.115).
In the norpinephrine group, heart rate was signifi cantly lower in comparison with baseline (mean change = –16.32 beats/minute, CI = –22.23 to –10.31, P <0.001) and so also was the occurrence of arrhythmias (RR = 2.34, CI = 1.456 to 3.775, P <0.001).
The SVRI, however, was signifi cantly higher in this group (diff erence in mean 185 dynes/cm5m2, CI = 141.214 to 229.05, P <0.001).
Patients who were on dopamine had signifi cantly better RVEF% (mean diff erence = 2.38%, CI = 1.058 to 3.671,
P <0.001) and a lower lactate level (mean diff erence = –0.170 mmol/l,
CI = –0.331 to –0.009, P = 0.038).
Urine output, oxygen delivery, MPAP and oxygen consumption were not signifi cantly diff erent between the two groups.
Conclusions Patients who received dopamine had a better right
ventricular ejection fraction, lower lactate levels, lower systemic
vascular resistance index and a trend towards a better cardiac index.
However, this group was noted to have more arrhythmias and a higher
baseline heart rate versus the norepinephrine group. Overall, there
was no diff erence in the 28-day mortality between the two groups.
Although there are certain hemodynamic advantages, we were unable
to deduce the superiority of one pressor. The results support the
current practice of individualizing the choice of an initial vasopressor
based on patient profile.
31st International Forum of Critical Care
Suspended animation-inducer hydrogen sulphide protects against organ injury during endotoxemia, but aggravates systemic inflammation - interesting!