1388/12/15 12:56 ب.ظ
ارسال شده در: داروهای قفسه بیهوشی ،
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 µg per kilogram of body weight per minute for dopamine or a dose of 0.19 µg 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
From the Department of Intensive Care, Erasme University Hospital (D.D.B., A.B., J.-L.V.); the Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles (J.D., P.G.); and the Department of Intensive Care, Centre Hospitalier Etterbeek Ixelles (D.C.) — all in Brussels; the Department of Intensive Care, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium (P.B., P.D.); the Department of Medicine III, Intensive Care Unit 13H1, Medical University of Vienna, Vienna (C.M.); and the Department of Anesthesia and Critical Care, Rio Hortega University Hospital, Valladolid, Spain (C.A.).
Address reprint requests to Dr. De Backer at the Department of Intensive Care, Erasme University Hospital, Rte. de Lennik 808, B-1070 Brussels, Belgium
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آخرین ویرایش: 1389/06/29 05:26 ب.ظ