Effectiveness of norepinephrine versus dopamine for septic shock: a meta analysis

Objective: To systematically evaluate the effect of norepinephrine and dopamine on patients with septic shock.

Methods: Randomized controlled trials (RCTs) about treatment of adults with septic shock with norepinephrine and dopamine were selected from PubMed, Embase, the Cochrane Library, CBM and CNKI databases. Meta analysis concerning the effect of norepinephrine and dopamine on hemodynamics and metabolism of patients with septic shock was conducted by using Review Manager 5.0 software. The results were expressed as risk ratio (RR) for dichotomous outcomes or standardized mean difference (SMD) for continuous data with 95% confidence intervals (95%CI).

Results: Eleven trials with 1718 cases were enrolled. Meta analysis showed that compared with dopamine, norepinephrine could decrease the mortality (RR=0.89, 95%CI 0.81-0.98, P=0.02). There were a decreased heart rate (SMD=-2.23, 95%CI -3.76 to -0.71, P=0.004), cardiac index (SMD=-0.71, 95%CI -1.07 to -0.35, P=0.0001) and an increased systemic vascular resistance index (SMD=1.39, 95%CI 0.54-2.23, P=0.001) were found in norepinephrine group compared with dopamine group. However, there were no significant differences on the effect of mean artery pressure (SMD=0.64, 95%CI -1.09-2.38, P=0.47), oxygen delivery (SMD=-0.54, 95%CI -1.50-0.42, P=0.27), oxygen consumption(SMD=-0.49, 95%CI -1.37-0.39, P=0.27) and lactic acid (SMD=-0.24, 95%CI -0.90-0.42, P=0.48) between these two vasopressors.

Conclusions: Norepinephrine is associated with an improved hemodynamics and decreased mortality compared with dopamine in septic shock patients.