Septic shock: norepinephrine reversed haemodynamic abnormalities better than dopamine

Clinical bottom line (level 1b)

  1. Patients with hyperdynamic septic shock after fluid resuscitation who received norepinephrine compared with dopamine were more likely to have haemodynamic stabilisation for at least 6 hours (NNT = 2 at unknown) .
  2. There was no clear effect on survival to discharge (although the study was too small to demonstrate this).
Martin et al: Chest 1993; 103: 1826-1831
Expires October 2003

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: intensive care unit, university hospital, France

32 patients (aged mean 53, 75% male) with hyperdynamic septic shock, defined as
  • systolic blood pressure < 90 mmHg
  • cardiac index > 4.0 l/min
  • decreased organ perfusion (altered mental status prior to sedation, or oliguria < 30 ml/ hour)
  • arterial blood lactate > 2.5 mmol/l
  • bacteraemia or identified source of infection

Control Group: (n = 16, 16 analysed): dopamine 2.5 µ g/kg/min increased after 5 to 10 minutes if haemodynamic abnormalities were not corrected up to a maximum dose of 25 µ g/kg/min
Experimental Group: (n = 16, 16 analysed): norepinephrine 0.5 µ g/kg/min increased after 5 to 10 minutes if haemodynamic abnormalities not corrected to a maximum of 5 µ g/kg/min
All patients received broad-spectrum antibiotics, respiratory support, fluid resuscitation and a pulmonary artery catheter. No patient received steroids.
100% followed for ? ?discharge from unit

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
haemodynamic stabilisation for at least 6 hours weeks 5
(31.3%)		 15
(93.8%)		 91%
(38% to 99%)		 62.5%
(36.9% to 88.12%)		 2
(1 to 3)
discharged alive weeks 6
(37.5%)		 9
(56.3%)		 30%
(-37% to 64%)		 18.8%
(-15.2% to 52.7%)		 5
(NNT = 2 to infinity;
NNH = 7 to infinity)

Comments

  1. The study is too small to show any difference in survival between the two regimens.

Citation

  1. Martin C, Papazian L, Perrin G, et al: Norepinephrine or dopamine for the treatment of hyperdynamic septic shock?. Chest 1993; 103: 1826-1831
Search Terms: ?
Contributor: Chris Ball and Musab Hayatli, October 1999
Reviewer: Janice L Zimmerman

Clinical Question.
Patient hyperdynamic septic shock
Intervention or Exposure norepinephrine
Comparison dopamine
Outcome haemodynamic stabilisation, death