Chest
Volume 103, Issue 6, June 1993, Pages 1826-1831
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Clinical Investigations in Critical Care
Norepinephrine or Dopamine for the Treatment of Hyperdynamic Septic Shock?

https://doi.org/10.1378/chest.103.6.1826Get rights and content

Study objective: To compare the ability of dopamine and norepinephrine to reverse hemodynamic and metabolic abnormalities of human hyperdynamic septic shock.

Design: Prospective, double-blind, randomized trial.

Setting: An ICU in a university hospital.

Patients: Adult patients with hyperdynamic septic shock after fluid resuscitation.

Interventions: Patients were assigned to receive either dopamine (2.5 to 25 µg/kg/min) or norepinephrine (0.5 to 5.0 µg/kg/min). If hemodynamic and metabolic abnormalities were not corrected with the maximum dose of one drug, the other was added.

Measurements and results: The aim of therapy was to achieve and maintain for at least 6 h all of the following: (1) systemic vascular resistance index >1, 100 dynes-s/cm5.m2 and/or mean systemic blood pressure ≥80 mm Hg; (2) cardiac index ≥4.0 L/min/m2; (3) oxygen delivery >550 ml/min/m2; and (4) oxygen uptake >150 ml/min/m2. With the use of dopamine 10 to 25 µg/kg/min, 5 of 16 patients (31 percent) were successfully treated, as compared with 15 of 16 patients (93 percent) by norepinephrine at a dose of 1.5 ± 1.2 µg/kg/min (p<0.001). Ten of 11 patients who did not respond to dopamine and remained hypotensive and oliguric were successfully treated with the addition of norepinephrine.

Conclusions: At the doses tested, norepinephrine was found, in the present study, to be more effective and reliable than dopamine to reverse the abnormalities of hyperdynamic septic shock. In the great majority of the study patients, norepinephrine was able to increase mean perfusing pressure without apparent adverse effect on peripheral blood flow or on renal blood flow (since urine flow was reestablished). At the same time, oxygen uptake was increased.

(Chest 1993; 103:1826-31)

Section snippets

METHODS

This prospective, randomized, double-blind study included 32 consecutive patients presenting with hyperdynamic septic shock. The study received approval of the Ethics Committee of our Institution, and written informed consent was obtained from a close relative. Hyperdynamic septic shock was defined as follows: (1) systolic blood pressure (SBP) of less than 90 mm Hg; (2) CI of more than 4.0 L/min/m2; (3) decreased organ perfusion as evidenced by altered mental status (prior to sedation) and/or

RESULTS

Thirty-two patients were included in the study. Table 1 shows that at the time of inclusion in the study, no difference was observed between the two groups with regard to clinical data of the 32 patients. Table 2 shows that at the time of inclusion to the study, no difference was observed between the two groups with regard to hemodynamic and metabolic parameters (baseline values). With the use of dopamine, 10 to 25 µg/kg/min, only 5 of 16 patients (31 percent) were successfully treated and

DISCUSSION

The main result of the present study is that, at the dosages tested, norepinephrine was more efficient and reliable than dopamine to reverse the hemodynamic abnormalities seen in hyperdynamic septic shock. Norepinephrine was also capable of being active when high-dose dopamine (25 μg/kg/min) failed. The traditional treatment of hemodynamic abnormalities of septic shock includes restoration of intravascular volume by fluid infusion and the use of adrenergic drugs if hypotension persists despite

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    Manuscript received September 16; revision accepted November 25.

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