Therapy

• norepinephrine ^c (started if systolic blood pressure < 90 mmHg; 0.5 µg/kg/min with increments of 0.3 - 0.6 µg/kg/min to maintain systolic bp >120/80) 

There is no clear benefit from dopamine ^a  (low-dose: 1 - 3 µg/kg/min). ^a

Why?

• Norepinephrine infusion increases urine output, decreases creatinine levels and increases creatinine clearance in around 80% of patients with septic shock. ^c
• Norepinephrine stabilises more patients in hyperdynamic septic shock than dopamine ^a
• Dopamine acutely increases urine output and creatinine clearance in patients with oliguria or established acute renal failure. ^b
• The effect on requirement for dialysis, or death is unclear. ^a

Norepinephrine stabilises septic shock better than dopamine

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
hyperdynamic septic shock a	norepinephrine	dopamine	haemodynamic stabilisation for at least at 6 hours	31%	200% (43% to 530%)	2 (1 to 3)