Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock
Recently a very important randomised trial published in "Lancet" from Annane and coll., (330 patients) comparing Norepinephrine plus Dobutamine versus Epinephrine alone for management of septic shock.
Background: International guidelines for management of septic shock recommend that dopamine or norepinephrine are preferable to epinephrine. However, no large comparative trial has yet been done. Aim of study was compare the efficacy and safety of norepinephrine plus dobutamine (whenever needed) with those of epinephrine alone in septic shock.
Methods: 330 patients were randomized to receive either epinephrine (n=161) or norepinephrine plus dobutamine (n=169), which were titrated to maintain mean blood pressure at 70 mm Hg or more.
The primary outcome was 28-day all-cause mortality.
Result:
- At day 28, there were 64 (40%) deaths in the epinephrine group and 58 (34%) deaths in the norepinephrine plus dobutamine group (p=0·31)
- There was no significant difference between the two groups in mortality rates at discharge from ICU, at hospital and by day 90
- There was no significant difference between the two groups time to haemodynamic success,
- There was no significant difference between the two groups time to vasopressor withdrawal,
- There was no significant difference between the two groups time course of SOFA score
- There was no significant difference between the two groups rates of serious adverse events were also similar
Conclusion: There is no evidence for a difference in efficacy and safety between epinephrine alone and norepinephrine plus dobutamine for the management of septic shock.
