Dopamine versus Norepinephrine for Septic Shock:A Systemic Review

Objective To systemically review the efficacy and safety of dopamine versus norepinephrine in patients with septic shock.Methods Database searches of MEDLINE,EMbase,Cochrane Controlled Trials Register,VIP,CNKI,and CBM(from the date of database establishment to June 2011) were conducted.Additional studies for collecting relevant data were retrieved via both references of articles and direct contact with authors.Prospectively,randomized controlled trials(RCTs) of dopamine compared with norepinephrine therapy in septic shock patients were selected.The quality of included trials was assessed and relevant data were extracted.Then statistical analysis was performed using RevMan 5.1.Results Nine trials with 3 179 participants were included.The results of meta-analysis showed: compared with norepinephrine,dopamine was associated with a significant 12% elevation in the risk ratio of in-hospital death events of septic shock patients(RR=1.12,95%CI 1.04 to 1.21,P=0.002).The risk of arrhythmias in dopamine group was 2.63-fold than that in norepinephrine group(RR=2.63,95%CI 1.51 to 4.55,P=0.000 6).The cardiac index of septic patients in dopamine group was higher than that in norepinephrine group(MD=0.42,95%CI 0.21 to 0.63,P0.000 1).No significant difference could be found in the heart rate(MD=17.05,95%CI –0.71 to 34.81,P=0.06) and mean arterial pressure(MD= –0.87,95%CI –24.97 to 7.62,P=0.30).Conclusion Findings from this meta-analysis suggest that compared with dopamine,norepinephrine significantly reduces both 28-day mortality of septic shock patients and incidence rate of arrhythmias.Norepinephrine is better than dopamine in aspects of efficacy and safety.