Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock

Ventura, Andréa M. C. MD, Shieh, Huei Hsin MD, Bousso, Albert MD, Góes, Patrícia F. MD, Fernandes, Iracema de Cássia F. O. MD, de Souza, Daniela C., Paulo, Rodrigo Locatelli Pedro MD, Chagas, Fabiana RN, Gilio, Alfredo E. MD

Critical Care Medicine, 2015

Links   Pub Med   Critical Care Medicine

The Bottom Line

Epinephrine is a better vasopressor than dopamine in fluid refractory shock

What They Did

  • This was a randomized controlled trial of 1-15 year olds with fluid refractory septic shock (not responsive to 40ml/kg crystalloid) with the primary outcome 28 days mortality
  • Randomized to either dopamine (5-10 μg/kg/min) or epinephrine (0.1-0.3 μg/kg/min) through a peripheral IV or IO
  • 13 (20.6%) died in the dopamine group and 4 (7%) died in the epinephrine group (p=0.033)
  • Dopamine and death, OR=6.5 (95% CI, 1.1-37.8; p=0.037)
  • Dopamine and healthcare-associated infection ,OR = 67.7 (95% CI, 5.0-910.8; p=0.001)

What You Can Do

  • This is further supportive of the fact that epinephrine is a more effective choice as an initial vasopressor in fluid refractory shock
  • Doses may not have been similar to what everyone uses – nor equivalent between doses
  • It was also a single site study – so the results should be interpreted in light of how this affects validity across the board