title: Comparison of dopamine and norepinephrine in the treatment of shock.
abstract: BACKGROUND
  Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other.
  
  
  METHODS
  In this multicenter, randomized trial, we assigned patients with shock to receive either dopamine or norepinephrine as first-line vasopressor therapy to restore and maintain blood pressure. When blood pressure could not be maintained with a dose of 20 microg per kilogram of body weight per minute for dopamine or a dose of 0.19 microg per kilogram per minute for norepinephrine, open-label norepinephrine, epinephrine, or vasopressin could be added. The primary outcome was the rate of death at 28 days after randomization; secondary end points included the number of days without need for organ support and the occurrence of adverse events.
  
  
  RESULTS
  The trial included 1679 patients, of whom 858 were assigned to dopamine and 821 to norepinephrine. The baseline characteristics of the groups were similar. There was no significant between-group difference in the rate of death at 28 days (52.5% in the dopamine group and 48.5% in the norepinephrine group; odds ratio with dopamine, 1.17; 95% confidence interval, 0.97 to 1.42; P=0.10). However, there were more arrhythmic events among the patients treated with dopamine than among those treated with norepinephrine (207 events [24.1%] vs. 102 events [12.4%], P<0.001). A subgroup analysis showed that dopamine, as compared with norepinephrine, was associated with an increased rate of death at 28 days among the 280 patients with cardiogenic shock but not among the 1044 patients with septic shock or the 263 with hypovolemic shock (P=0.03 for cardiogenic shock, P=0.19 for septic shock, and P=0.84 for hypovolemic shock, in Kaplan-Meier analyses).
  
  
  CONCLUSIONS
  Although there was no significant difference in the rate of death between patients with shock who were treated with dopamine as the first-line vasopressor agent and those who were treated with norepinephrine, the use of dopamine was associated with a greater number of adverse events. (ClinicalTrials.gov number, NCT00314704.)
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Brussels, Belgium. ddebacke@ulb.ac.be
authors.forename: Daniel
authors.initials: D
authors.lastname: De Backer
authors.forename: Patrick
authors.initials: P
authors.lastname: Biston
authors.forename: Jacques
authors.initials: J
authors.lastname: Devriendt
authors.forename: Christian
authors.initials: C
authors.lastname: Madl
authors.forename: Didier
authors.initials: D
authors.lastname: Chochrad
authors.forename: Cesar
authors.initials: C
authors.lastname: Aldecoa
authors.forename: Alexandre
authors.initials: A
authors.lastname: Brasseur
authors.forename: Pierre
authors.initials: P
authors.lastname: Defrance
authors.forename: Philippe
authors.initials: P
authors.lastname: Gottignies
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D003131:Combined Modality Therapy; D004298:Dopamine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D057194:Intention to Treat Analysis; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000009:adverse effects / Q000627:therapeutic use*; D012769:Shock / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D004298:Dopamine; D009638:Norepinephrine