Comparison of dopamine and norepinephrine in the treatment of shock.
@article{DeBacker2010ComparisonOD, title={Comparison of dopamine and norepinephrine in the treatment of shock.}, author={Daniel De Backer and Patrick Biston and Jacques Devriendt and Christian Madl and Didier Chochrad and C{\'e}sar Aldecoa and Alexandre Brasseur and Pierre Defrance and P. Gottignies and Jean Louis Vincent}, journal={The New England journal of medicine}, year={2010}, volume={362 9}, pages={ 779-89 } }
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…
1,331 Citations
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The use of dopamine was associated with a greater number of adverse events in the overall population and an unexpected increase in the rate of death in the subgroup of patients with cardiogenic shock.
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It is confirmed that vasopressin dose relative toweight was independently associated with change in MAP at 1, 6, and 12 hours, whereas changes in NE dosing were not, and fixed-dose vasopressingin may not be sufficient in obese septic shock patients with a BMI ≥30 kg/m2.
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The results of this retrospective cohort study evaluated adults who received monotherapy with either norepinephrine or vasopressin as initial vasoactive therapy for the management of septic shock, suggesting noninferiority of vasopressed for the achievement of a mean arterial pressure goal in the first 6 hours of shock onset.
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The first-line therapy remains norepinephrine as it is associated with minimal adverse effects and appears to be associated by the best outcome in network meta-analyses and observational studies suggest an increased risk of death.
Choosing catecholamine therapy for shock
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- 2011
Two randomized trials comparing dopamine and norepinephrine as the first vasopressor agent raised major concerns on the use of dopamine, and suggest that nore Alpinephrine may be the first-choice adrenergic agent.
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