Comparison of norepinephrine and dopamine in the management of septic shock using impedance cardiography

Abstract

Objective: Vasoconstrictors are one of the therapeutic modalities in the treatment of septic shock. In the present study, we have compared the effects of dopamine and norepinephrine in the treatment of septic shock with pre-defi ned end-points and continuous non-invasive cardiac output monitoring using impedance cardiography. Design: Randomized controlled trial. Settings: Sixteen-bedded mixed intensive care unit of a tertiary care teaching institution. Materials and Methods: The study included 50 consecutive patients presenting with septic shock and divided randomly into two groups with 25 patients in each group. Group I patients were treated with dopamine and those in Group II were treated with norepinephrine. They were optimized with fl uid resuscitation upto CVP>10 cm of H 2 O, packed red cells transfusion upto hematocrit >30, oxygenation and ventilation upto PaO 2 >60 mmHg before the inotropes were started. The goal of therapy was to achieve and maintain for six hours, all of the following: (1) SBP >90 mm Hg, (2) SVRI >1100 dynes.s/cm 5 m 2 , (3) Cardiac Index >4.0L/min/m 2 , (4) IDO 2 >550 ml/min/m 2 and (5) IVO 2 >150 ml/min/m 2. Measurements: The demographic data, baseline parameters and post-treatment parameters were statistically analyzed by using t-test. Results: The post-treatment parameters were statistically signifi cant showing the superiority of norepinephrine over dopamine in optimization of hemodynamics and patient survival. Signifi cant improvement in systolic blood pressure, heart rate, cardiac index, SVRI, IVO 2 and urine output were found in norepinephrine group than the dopamine group. Dopamine showed a response in 10 out of 25 patients up to a maximum dose of 25 mcg/kg/min while with norepinephrine, 19 patients responded up to a maximum dose of 2.5 mcg/kg/min The hemodynamic parameters were preserved in norepinephrine group with better preservation of organ perfusion and oxygen utilization with maintenance of splanchnic and renal blood fl ow as evidenced by signifi cant increase in O2 uptake and urine fl ow. Conclusion: Norepinephrine was more useful in reversing the hemodynamic and metabolic abnormalities of septic shock compared to dopamine at the doses tested.

Sex- and Gender-Based Analysis on Norepinephrine Use in Septic Shock: Why Is It Still a Male World?

“…Nine eligible manuscripts were identified [43][44][45][46][47][48][49][50][51]. The main features of the selected studies are summarized in Tables 1 and 2.…”

“…The overall population included 2126 patients; among them, 919 (43.2%) were female. In three out of nine manuscripts, NE was considered more effective and reliable than DA [43,44,48]; in the remaining, the efficacy of the two agents was considered comparable but DA was associated with more side effects (even life-threatening) than NE [45][46][47][49][50][51]. In 21 (1%) patients derived from the analysis of Ruokonen et al [45], sex was not even specified.…”

The Efficacy and Safety of Vasopressors for Septic Shock Patients: A Systemic Review and Network Meta-Analysis

“…We included 38 trials from the database search and 9 unpublished studies from trial registries or other methods. Ultimately, 47 RCTs (comprising 7,798 patients) (10–56) performed between 1993 and 2021 were included. Twenty-one types of vasoactive agents were compared in the included trials, including single administration of NE, EP, enoximone (EX), dopexamine (DX), dobutamine (DB), dopamine (DA), levosimendan (LE), vasopressin (VP), TP, SP, phenylephrine (PE), placebo (PA) and other catecholamines (CE), as well as combined therapies including NE plus DB (NE_DB), NE plus DX (NE_DX), NE plus EP (NE_EP), NE plus TP (NE_TP), NE plus VP (NE_VP), TP plus DB (TE_DB), and TP plus CE (TP_CE).…”

The effect of vasoactive drugs on mortality in patients with severe sepsis and septic shock. A network meta-analysis of randomized trials

“…The most frequently investigated comparators were norepinephrine (1,218 patients -13 studies) (7-11, 26, 31, 34, 39-41, 47, 48), dopamine (1,141 patients -8 studies) [7,30,[39][40][41][47][48][49], vasopressin (424 patients -5 studies) (9,10,34,36,38), epinephrine (302 patients -6 studies) [8,27,35,37,49,50], combination of norepinephrine plus dobutamine (195 patients -3 studies) [27,35,50], and dobutamine (129 patients -6 studies) [28,32,37,42,44,45].…”

“…Longest follow up was variable among different studies. The most frequently reported follow-up were ICU stay in 14 studies [10,11,29,31,32,34,36,39,41,42,46,48,50], 28 or 30 days in further 14 studies [7-9, 27, 28, 30, 33, 37, 44, 47, 49, 51, 52, 53], and 90 days in 5 studies [9,10,27,51,52].…”