Dopamine versus Norepinephrine for Septic Shock: A Systemic Review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHAO Yang ¹ , WANG Qian ² ,  ZANG Bin ¹

1. Department of ICU, Shengjing Hospital Affiliated to China Medical University, Shenyang 110004, China;2. Department of Emergency, the 4th Hospital Affiliated to China Medical University, Shenyang 110032, China;

Corresponding author：

ZANG Bin, Email: zangbin_66@126.com

Keywords：

Dopamine; Norepinephrine; Septic shock; Randomized controlled trial; Systemic review; Meta-analysis

DOI：

10.7507/1672-2531.20120111

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systemically review the efficacy and safety of dopamine versus norepinephrine in patients with septic shock.
Methods Database searches of MEDLINE, EMbase, Cochrane Controlled Trials Register, VIP, CNKI, and CBM (from the date of database establishment to June 2011) were conducted. Additional studies for collecting relevant data were retrieved via both references of articles and direct contact with authors. Prospectively, randomized controlled trials (RCTs) of dopamine compared with norepinephrine therapy in septic shock patients were selected. The quality of included trials was assessed and relevant data were extracted. Then statistical analysis was performed using RevMan 5.1.
Results Nine trials with 3 179 participants were included. The results of meta-analysis showed: compared with norepinephrine, dopamine was associated with a significant 12% elevation in the risk ratio of in-hospital death events of septic shock patients (RR=1.12, 95%CI 1.04 to 1.21, P=0.002). The risk of arrhythmias in dopamine group was 2.63-fold than that in norepinephrine group (RR=2.63, 95%CI 1.51 to 4.55, P=0.000 6). The cardiac index of septic patients in dopamine group was higher than that in norepinephrine group (MD=0.42, 95%CI 0.21 to 0.63, P lt;0.000 1). No significant difference could be found in the heart rate (MD=17.05, 95%CI –0.71 to 34.81, P=0.06) and mean arterial pressure (MD= –0.87, 95%CI –24.97 to 7.62, P=0.30).
Conclusion Findings from this meta-analysis suggest that compared with dopamine, norepinephrine significantly reduces both 28-day mortality of septic shock patients and incidence rate of arrhythmias. Norepinephrine is better than dopamine in aspects of efficacy and safety.

Citation： ZHAO Yang,WANG Qian,ZANG Bin. Dopamine versus Norepinephrine for Septic Shock: A Systemic Review. Chinese Journal of Evidence-Based Medicine, 2012, 12(6): 679-685. doi: 10.7507/1672-2531.20120111 Copy

1.	Kampmeier TG, Rehberg S, Westphal M, et al. Vasopressin in sepsis and septic shock. Minerva Anestesiol, 2010, 76(10): 844-850.
2.	Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Intensive Care Med, 2004, 30(4): 536-855.
3.	Martin C, Viviand X, Leone M, et al. Effect of norepinephrine on the outcome of septic shock. Crit Care Med, 2000, 28(8): 2758-2765.
4.	Sakr Y, Reinhart K, Vincent JL, et al. Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med, 2006, 34(3): 589-597.
5.	Povoa PR, Carneiro AH, Ribeiro OS, et al. Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study). Crit Care Med, 2009, 37(2): 410-416.
6.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
7.	Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
8.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327: 557-560.
9.	Egger M, Altman DG, Smith GD. Systematic reviews in health-care: meta-analysis in context. 2nd edn. BMJ Books, Wiley: London, 2001.
10.	De Backer D, Biston P, Devriendt J, et al. SOAP II Investigators.Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med, 2010, 362(9): 779-789.
11.	Patel GP, Grahe JS, Sperry M, et al. Efficacy and safety of dopamine versus norepinephrine in the management of septic shock. Shock, 2010, 33(4): 375-380.
12.	Mathur SK, Dhunna R, Chakraborty A. Comparison of norepinephrine and dopamine in the management of septic shock using impedance cardiography. Indian J Crit Care Med, 2007, 1(5): 186-191.
13.	Sakr Y, Reinhart K, Vincent JL, et al. Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med, 2006, 34(3): 589-597.
14.	Guérin JP, Levraut J, Samat-Long C, et al. Effects of dopamine and norepinephrine on systemic and hepatosplanchnic hemodynamics, oxygen exchange, and energy balance in vasoplegic septic patients. Shock, 2005, 23(1): 18-24.
15.	Simon Grahe JJ, Patel GP, Elpern E, et al. The safety of dopamine versus norepinephrine as vasopressor therapy in septic shock (Abstract). Chest, 2005, 128: 219S-220S.
16.	Marik PE, Mohedin M. The contrasting effects of dopamine and norepinephrine on systemic and splanchnic oxygen utilization in hyperdynamic sepsis. JAMA, 1994, 272(17): 1354-1357.
17.	Martin C, Papazian L, Perrin G, et al. Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest, 1993, 103(6): 1826-1831.
18.	Ruokonen E, Takala J, Kari A, et al. Regional blood flow and oxygen transport in septic shock. Crit Care Med, 1993, 21(9): 1296-1303.
19.	Martin C, Viviand X, Leone M, et al. Effect of norepinephrine on the outcome of septic shock. Crit Care Med, 2000, 28(8): 2758-2765.
20.	Hamzaoui O, Georger JF, Monnet X, et al. Early administration of norepinephrine increases cardiac preload and cardiac output in septic patients with life-threatening hypotension. Crit Care, 2010, 14(4): R142.
21.	Póvoa PR, Carneiro AH, Ribeiro OS, et al. Portuguese Community-Acquired Sepsis Study Group. Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study). Crit Care Med, 2009, 37(2): 410-416.
22.	Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group: Low dose dopamine in patients with early renal dysfunction: a placebo controlled trial. Lancet, 2000, 356: 2139-2143.
23.	Argalious M, Motta P, Khandwala F, et al. “Renal dose” dopamine is associated with the risk of new-onset atrial fibrillation after cardiac surgery. Crit Care Med, 2005, 33(6): 1327-1332.
24.	Overgaard CB, Dzavik V. Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation, 2008, 118: 1047-1056.

1. Kampmeier TG, Rehberg S, Westphal M, et al. Vasopressin in sepsis and septic shock. Minerva Anestesiol, 2010, 76(10): 844-850.
2. Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Intensive Care Med, 2004, 30(4): 536-855.
3. Martin C, Viviand X, Leone M, et al. Effect of norepinephrine on the outcome of septic shock. Crit Care Med, 2000, 28(8): 2758-2765.
4. Sakr Y, Reinhart K, Vincent JL, et al. Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med, 2006, 34(3): 589-597.
5. Povoa PR, Carneiro AH, Ribeiro OS, et al. Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study). Crit Care Med, 2009, 37(2): 410-416.
6. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
7. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
8. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327: 557-560.
9. Egger M, Altman DG, Smith GD. Systematic reviews in health-care: meta-analysis in context. 2nd edn. BMJ Books, Wiley: London, 2001.
10. De Backer D, Biston P, Devriendt J, et al. SOAP II Investigators.Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med, 2010, 362(9): 779-789.
11. Patel GP, Grahe JS, Sperry M, et al. Efficacy and safety of dopamine versus norepinephrine in the management of septic shock. Shock, 2010, 33(4): 375-380.
12. Mathur SK, Dhunna R, Chakraborty A. Comparison of norepinephrine and dopamine in the management of septic shock using impedance cardiography. Indian J Crit Care Med, 2007, 1(5): 186-191.
13. Sakr Y, Reinhart K, Vincent JL, et al. Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med, 2006, 34(3): 589-597.
14. Guérin JP, Levraut J, Samat-Long C, et al. Effects of dopamine and norepinephrine on systemic and hepatosplanchnic hemodynamics, oxygen exchange, and energy balance in vasoplegic septic patients. Shock, 2005, 23(1): 18-24.
15. Simon Grahe JJ, Patel GP, Elpern E, et al. The safety of dopamine versus norepinephrine as vasopressor therapy in septic shock (Abstract). Chest, 2005, 128: 219S-220S.
16. Marik PE, Mohedin M. The contrasting effects of dopamine and norepinephrine on systemic and splanchnic oxygen utilization in hyperdynamic sepsis. JAMA, 1994, 272(17): 1354-1357.
17. Martin C, Papazian L, Perrin G, et al. Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest, 1993, 103(6): 1826-1831.
18. Ruokonen E, Takala J, Kari A, et al. Regional blood flow and oxygen transport in septic shock. Crit Care Med, 1993, 21(9): 1296-1303.
19. Martin C, Viviand X, Leone M, et al. Effect of norepinephrine on the outcome of septic shock. Crit Care Med, 2000, 28(8): 2758-2765.
20. Hamzaoui O, Georger JF, Monnet X, et al. Early administration of norepinephrine increases cardiac preload and cardiac output in septic patients with life-threatening hypotension. Crit Care, 2010, 14(4): R142.
21. Póvoa PR, Carneiro AH, Ribeiro OS, et al. Portuguese Community-Acquired Sepsis Study Group. Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study). Crit Care Med, 2009, 37(2): 410-416.
22. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group: Low dose dopamine in patients with early renal dysfunction: a placebo controlled trial. Lancet, 2000, 356: 2139-2143.
23. Argalious M, Motta P, Khandwala F, et al. “Renal dose” dopamine is associated with the risk of new-onset atrial fibrillation after cardiac surgery. Crit Care Med, 2005, 33(6): 1327-1332.
24. Overgaard CB, Dzavik V. Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation, 2008, 118: 1047-1056.

Chinese Journal of Evidence-Based Medicine

Dopamine versus Norepinephrine for Septic Shock: A Systemic Review

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