Sunday, March 14, 2010

Research Highlights: Treatment of Shock with Different First-Line Vasopressor Agents

Treatment of Shock with Different First-Line Vasopressor Agents
By: Caroline Melhado

Researchers performed a multicenter, randomized trail to investigate the difference in death rate for patients who were treated with dopamine or norepinephrine as treatment for shock. While there was no statistical difference in the rate of death between the group who was given dopamine and the group given norepinephrine, differing rates of adverse affects show that norepinephrine should be recommended as the first-line defense for shock victims.

The study used 1679 individuals who underwent septic shock, cardiogenic shock and hypovolemic shock. Of the 858 patients in the dopamine group 52.5% died after 28 days, and of the 821 patients in the norepinephrine group 48.5% died (P=0.10). These results did not show significant difference, however stratified tables between different types of shock showed that dopamine had a higher rate of death in cardiogenic shock. Additionally there was a significant increase in arrhythmic events in the dopamine group than the epinephrine group across all categories of stroke type.

Currently both dopamine and norepinethrine are recommended as first-line vasopressor agents during shock, however this data might change recommendations. The mechanisms of these differences between the two drugs is still widely debated, however researchers offer some explanation; dopamine and norepinethrine might differently affect the kidneys, arterial blood flow in the splanchnic region and the hypothalamic-pituitary-adrenal axis which regulates many homeostatic processes. More research will need to be done to determine the mechanisms of these two vasopressor agents.

NEJM Volume 362:779-789
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