Comparison of Dopamine and Norepinephrine in the Treatment of Shock

Backer, Daniel De; Biston, Patrick; Devriendt, Jacques; Madl, Christian; Chochrad, Didier; Aldecoa, César; Brasseur, Alexandre; Defrance, P; Gottignies, Philippe; Vincent, Jean‐Louis

doi:10.1056/nejmoa0907118

Cited by 1,554 publications

(1,044 citation statements)

References 26 publications

Supporting

Mentioning

913

Contrasting

Unclassified

Order By: Relevance

“…We refrain from giving any recommendations or suggestions on using dobutamine or dopamine for patients with hypovolemic shock, due to the lack of data and no relevant populations to extrapolate from. Importantly, we strongly recommend that if clinicians prefer to use dopamine rather than dobutamine in this population, they do so in the context of high‐quality RCTs, given the harm associated with use of dopamine in patients with septic shock17, 18 and in a subgroup analysis of patients with cardiogenic shock in the SOAP 2 trial 39. Importantly, adequate fluid resuscitation should be a priority in patients with hypovolemic shock.

We suggest against routine use of dobutamine as inotropic agent for patients with hypovolemic shock, as compared to placebo/no treatment (weak recommendation, very low quality of evidence).

…”

Section: Resultsmentioning

confidence: 99%

Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

Møller

Granholm

Junttila

et al. 2018

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

BackgroundAdult critically ill patients often suffer from acute circulatory failure and those with low cardiac output may be treated with inotropic agents. The aim of this Scandinavian Society of Anaesthesiology and Intensive Care Medicine guideline was to present patient‐important treatment recommendations on this topic.MethodsThis guideline was developed according to GRADE. We assessed the following subpopulations of patients with shock: (1) shock in general, (2) septic shock, (3) cardiogenic shock, (4) hypovolemic shock, (5) shock after cardiac surgery, and (6) other types of shock, including vasodilatory shock. We assessed patient‐important outcome measures, including mortality and serious adverse reactions.ResultsFor all patients, we suggest against the routine use of any inotropic agent, including dobutamine, as compared to placebo/no treatment (very low quality of evidence). For patients with shock in general, and in those with septic and other types of shock, we suggest using dobutamine rather than levosimendan or epinephrine (very low quality of evidence). For patients with cardiogenic shock and in those with shock after cardiac surgery, we suggest using dobutamine rather than milrinone (very low quality of evidence). For the other clinical questions, we refrained from giving any recommendations or suggestions.ConclusionsWe suggest against the routine use of any inotropic agent in adult patients with shock. If used, we suggest using dobutamine rather than other inotropic agents for the majority of patients, however, the quality of evidence was very low, implying high uncertainty on the balance between the benefits and harms of inotropic agents.

show abstract

We suggest against routine use of dobutamine as inotropic agent for patients with hypovolemic shock, as compared to placebo/no treatment (weak recommendation, very low quality of evidence).

…”

Section: Resultsmentioning

confidence: 99%

Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

Møller

Granholm

Junttila

et al. 2018

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

show abstract

“…In a predefined subgroup of patients with cardiogenic shock included in the SOAP II trial (norepinephrine vs. dopamine in patients with shock in general),10 no difference in the overall effect of treatment between the three subgroups assessed was reported ( P = 0.87 for interaction). However, the rate of death at 28 days was significantly higher among patients with cardiogenic shock who were treated with dopamine than among those treated with norepinephrine (Table S3A) 10.…”

Section: Resultsmentioning

confidence: 99%

“…However, the rate of death at 28 days was significantly higher among patients with cardiogenic shock who were treated with dopamine than among those treated with norepinephrine (Table S3A) 10. No other outcome measures of interest have been assessed.…”

Section: Resultsmentioning

confidence: 99%

Scandinavian SSAI clinical practice guideline on choice of first‐line vasopressor for patients with acute circulatory failure

Møller

Claudius

Junttila

et al. 2016

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

BackgroundAdult critically ill patients often suffer from acute circulatory failure, necessitating use of vasopressor therapy. The aim of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) task force for Acute Circulatory Failure was to present clinically relevant, evidence‐based treatment recommendations on this topic.MethodsThis guideline was developed according to standards for trustworthy guidelines, including a systematic review of the literature and use of the GRADE methodology for assessment of the quality of evidence and for moving from evidence to recommendations. We assessed the following subpopulations of patients with acute circulatory failure: 1) shock in general, 2) septic shock, 3) cardiogenic shock, 4) hypovolemic shock and 5) other types of shock, including vasodilatory shock. We assessed patient‐important outcome measures, including mortality, serious adverse reactions and quality‐of‐life.ResultsFor patients with shock in general and those with septic shock, we recommend using norepinephrine rather than dopamine, and we suggest using norepinephrine rather than epinephrine, vasopressin analogues, and phenylephrine. For patients with cardiogenic shock and those with hypovolemic shock, we suggest using norepinephrine rather than dopamine, and we provide no recommendations/suggestions of norepinephrine vs. epinephrine, vasopressin analogues, and phenylephrine. For patients with other types of shock, including vasodilatory shock, we suggest using norepinephrine rather than dopamine, epinephrine, vasopressin analogues, and phenylephrine.ConclusionsWe recommend using norepinephrine rather than other vasopressors as first‐line treatment for the majority of adult critically ill patients with acute circulatory failure.

show abstract

“…Indeed, one often assumes that the entire ICU team is supporting a trial that is conducted in that ICU. Physician refusals are often not reported [1][2][3][4][5]. When reported, they usually comprise a minority (\10 %) of the reasons evoked for non-inclusion of critically ill patients in investigator-led clinical trials [6,7].…”

mentioning

confidence: 99%

Physicians declining patient enrollment in clinical trials: what are the implications?

Backer

Schortgen²

2013

Intensive Care Med

Self Cite

View full text Add to dashboard Cite

Comparison of Dopamine and Norepinephrine in the Treatment of Shock

Cited by 1,554 publications

References 26 publications

Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

Scandinavian SSAI clinical practice guideline on choice of first‐line vasopressor for patients with acute circulatory failure

Physicians declining patient enrollment in clinical trials: what are the implications?

Contact Info

Product

Resources

About