Monday, April 25, 2011

Norepinephrine or Dopamine?

It looks like...we may have a winner. Yes
Im talking about the use of vasopressors in the setting of septic shock. There have been a few clinical trials done to see if one vasopressor is better than the other in terms of mortality from septic shock. (the latest one was from SOAP 2 trial from NEJM 2010)We didnt have a clear result so far.

But  a recent meta analysis of the trials have shown that norepinephrine might be better than Dopamine. It is associated with a 9% reduction in in-hospital and 28 day mortality in patients with septic shock. Patients on Dopamine had significantly increased incidence of cardiac arrhythmias compared to norepinephrine. This is probably the reason behind the poor performance of Doapmine...as we all know that arrhythmias can hinder cardiac function. The same finding of increased cardiac arrhythmias with Dopamine was also noted in the above SOAP trial.
The above meta-analysis was done at Thomas Jefferson University.(J of Int Care Med ...March 2011)

Would be reasonable to use nor-epinephrine as the first line vasopressor for patients with septic shock. Infact according to the SOAP trial,dopamine was associated with an increased 28 day mortality in patients with cardiogenic shock, as compared to norepinephrine!

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