title: Norepinephrine or dopamine for septic shock: systematic review of randomized clinical trials.
abstract: BACKGROUND
  There is debate as to the vasopressor agent of choice in patients with septic shock. According to current guidelines either dopamine or norepinephrine may be considered as the first-line agent for the management of refractory hypotension of septic shock.
  
  
  OBJECTIVE
  The aim of this systematic review was to evaluate randomized clinical trials which compared norepinephrine versus dopamine in critically ill patients with septic shock or in a population of critically ill patients with shock predominantly secondary to sepsis.
  
  
  METHODS
  MEDLINE, Embase, Scopus, Cochrane Register of Controlled Trials and citation review of relevant primary and review articles.
  
  
  METHODS
  Randomized clinical trials that compared norepinephrine with dopamine in critically ill adults with sepsis and reported the 28-day or in-hospital mortality.
  
  
  METHODS
  We abstracted data on study design, study setting, patient population, 28-day mortality or in-hospital mortality, rate of arrhythmias, hospital length of stay, and ICU length of stay.
  
  
  RESULTS
  Six studies met our inclusion criteria. These studies included a total of 2043 participants, with 995 in the norepinephrine and 1048 in the dopamine groups. There were 479 (48%) deaths in the norepinephrine group and 555 (53%) deaths in the dopamine group. There was statistically significant superiority of norepinephrine over dopamine for the outcome of in-hospital or 28-day mortality: pooled RR: 0.91 (95% CI 0.83 to 0.99; P = .028). We also found a statistically significant decrease in the rate of cardiac arrhythmias in the norepinephine group as compared to the dopamine group: pooled RR: 0.43 (95% CI 0.26 to 0.69; P ≤ .001). A subgroup analysis that pooled studies in which all the randomized patients had septic shock demonstrated that norepinephrine improved in-hospital or 28-day mortality; however, the results were no longer statistically significant.
  
  
  CONCLUSIONS
  The analysis of the pooled studies that included a critically ill population with shock predominantly secondary to sepsis showed superiority of norepinephrine over dopamine for in-hospital or 28-day mortality.
authors: Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
authors: Tajender S
authors: TS
authors: Vasu
authors: Rodrigo
authors: R
authors: Cavallazzi
authors: Amyn
authors: A
authors: Hirani
authors: Gary
authors: G
authors: Kaplan
authors: Benjamin
authors: B
authors: Leiby
authors: Paul E
authors: PE
authors: Marik
mesh_terms: D000328:Adult; D004298:Dopamine / Q000627:therapeutic use*; D015259:Dopamine Agents / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D009638:Norepinephrine / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012772:Shock, Septic / Q000188:drug therapy* / Q000209:etiology; D014655:Vascular Resistance / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D015259:Dopamine Agents; D014662:Vasoconstrictor Agents; D004298:Dopamine; D009638:Norepinephrine