Featured Research

from universities, journals, and other organizations

Safety data favor norepinephrine over dopamine for shock

Date:
March 4, 2010
Source:
Emory University
Summary:
Physicians treating patients with shock should consider norepinephrine instead of dopamine as a tool for stabilizing blood pressure, according to a new editorial.

Physicians treating patients with shock should consider norepinephrine instead of dopamine as a tool for stabilizing blood pressure, according to an editorial in the March 4, 2010, issue of the New England Journal of Medicine (NEJM).

Jerrold Levy, MD, FAHA, professor and deputy chair for research, Department of Anesthesiology, Emory University School of Medicine, and co-director of cardiothoracic anesthesiology, Emory Healthcare, authored the editorial.

The editorial accompanies a report in the same issue of NEJM on a European clinical trial evaluating dopamine and norepinephrine in shock patients. The randomized trial, led by Daniel De Backer, MD, PhD, at Erasme University Hospital in Belgium, compared 28-day mortality in 1679 patients treated for shock with dopamine or norepinephrine in Austria, Belgium and Spain between 2003 and 2007.

"Dopamine has been commonly used as a first-line therapy for shock at many hospitals for years, partially because of the widespread perception that norepinephrine is associated with adverse events," Levy says. "The current study supports the concept that shock from any cause carries a high risk of death, and raises significant concerns about the safety of dopamine."

Shock, or dangerously low blood pressure, can occur as a result of sepsis (severe inflammation resulting from bacterial infection), heart failure (cardiogenic), hemorrhage (severe blood loss) or anaphylaxis. Most of the patients (62.2 percent) in the European trial had septic shock, 16.7 percent had heart failure and 15.7 percent hemorrhage.

The authors of the clinical study reported no overall difference in death rates at 28 days. However, heart arrhythmias were almost twice as common in the dopamine group (24.1 percent vs 12.4 percent) and mortality was higher for patients with cardiogenic shock treated with dopamine.

A previous observational study showed that dopamine's use in intensive care units added to the risk of death, and rapid heart rate is known to be a frequent side effect of dopamine, Levy notes.

Norepinephrine has been used to stabilize patients' blood pressure during cardiac and non cardiac surgery, and in intensive care units after surgery. Vasopressin, although not studied in the European clinical trial, is also a viable alternative treatment for shock, Levy says.

The hormones dopamine and norepinephrine have functions in the brain, helping neurons communicate, as well as in the body to maintain vascular tone. In an emergency situation, they both can increase blood pressure by constricting blood vessels. Dopamine is the precursor to norepinephrine in the sympathetic nervous system, and thus acts indirectly.

"The data challenge consensus guidelines that recommend dopamine as the initial vasopressor for increasing arterial pressure in the case of septic shock or cardiogenic shock," Levy writes in the editorial.

"In addition, norepinephrine needs to be considered as an initial therapeutic agent for patients in circulatory shock. … The results of the study by De Backer et al should also put an end to the outdated view that the use of norepinephrine increases the risk of death."

\


Story Source:

The above story is based on materials provided by Emory University. Note: Materials may be edited for content and length.


Journal Reference:

  1. De Backer, Daniel, Biston, Patrick, Devriendt, Jacques, Madl, Christian, Chochrad, Didier, Aldecoa, Cesar, Brasseur, Alexandre, Defrance, Pierre, Gottignies, Philippe, Vincent, Jean-Louis, the SOAP II Investigators. Comparison of Dopamine and Norepinephrine in the Treatment of Shock. New England Journal of Medicine, 2010; 362 (9): 779 DOI: 10.1056/NEJMoa0907118

Cite This Page:

Emory University. "Safety data favor norepinephrine over dopamine for shock." ScienceDaily. ScienceDaily, 4 March 2010. <www.sciencedaily.com/releases/2010/03/100303192442.htm>.
Emory University. (2010, March 4). Safety data favor norepinephrine over dopamine for shock. ScienceDaily. Retrieved October 22, 2014 from www.sciencedaily.com/releases/2010/03/100303192442.htm
Emory University. "Safety data favor norepinephrine over dopamine for shock." ScienceDaily. www.sciencedaily.com/releases/2010/03/100303192442.htm (accessed October 22, 2014).

Share This



More Health & Medicine News

Wednesday, October 22, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

CDC Revamps Ebola Guidelines After Criticism

CDC Revamps Ebola Guidelines After Criticism

Newsy (Oct. 21, 2014) The Centers for Disease Control and Prevention have issued new protocols for healthcare workers interacting with Ebola patients. Video provided by Newsy
Powered by NewsLook.com
WHO: Ebola Vaccine Trials to Start a in January

WHO: Ebola Vaccine Trials to Start a in January

AP (Oct. 21, 2014) Tens of thousands of doses of experimental Ebola vaccines could be available for "real-world" testing in West Africa as soon as January as long as they are deemed safe in soon to start trials, the World Health Organization said Tuesday. (Oct. 21) Video provided by AP
Powered by NewsLook.com
First-Of-Its-Kind Treatment Gives Man Ability To Walk Again

First-Of-Its-Kind Treatment Gives Man Ability To Walk Again

Newsy (Oct. 21, 2014) A medical team has for the first time given a man the ability to walk again after transplanting cells from his brain onto his severed spinal cord. Video provided by Newsy
Powered by NewsLook.com
CDC Issues New Ebola Guidelines for Health Workers

CDC Issues New Ebola Guidelines for Health Workers

Reuters - US Online Video (Oct. 21, 2014) The U.S. Centers for Disease Control and Prevention has set up new guidelines for health workers taking care of patients infected with Ebola. Linda So reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins