Norepinephrine or Dopamine for the Treatment of Hyperdynamic Septic Shock?

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…Rationale The physiologic effects of vasopressors and combined inotrope/vasopressor selection in septic shock are outlined in an extensive number of literature reviews [252][253][254][255][256][257][258][259][260][261]. Norepinephrine increases MAP due to its vasoconstrictive effects, with little change in heart rate and less increase in stroke volume compared with dopamine.…”

Prevention and Treatment of Acute Renal Failure in Sepsis

“…Several non-controlled studies in patients with sepsis have, indeed, shown that norepinephrine augmented urine output and GFR (12). The only randomized trial available reported that norepinephrine administration in 32 patients with septic shock resulted in a higher BP, systemic vascular resistance, and diuresis than high-dose dopamine (13). A prospective observational study in 97 patients with septic shock found a lower mortality in patients treated with norepinephrine than in those treated with other vasopressorsmainly high-dose dopamine (14).…”

Comment on “A comparison of epinephrine and norepinephrine in critically Ill patients”

“…For example, the authors report that in septic-shock patients the median time to attain target MAP was 35.1 and 50.0 h for epinephrine and norepinephrine, respectively. However, in a recent study by Annane et al [3] all patients in both epinephrine and norepinephrine groups achieved MAP C 70 mmHg on day 1, and Martin et al reported that 93% of their septic-shock patients responded to norepinephrine targeted to MAP [ 80 mmHg within 6 h of therapy [4]. The specific practice of pressor titration, other aspects of circulatory support, and use of infection control measures may have affected the time to achieve target MAP in this study.…”