Trial reportChest1993
Norepinephrine or dopamine for the treatment of hyperdynamic septic shock?
Trial report in Chest, 1993. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 82 papers, 11 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
82 citing papers in PubMed, 11 syntheses or guidelines pooled it, 458 citations in OpenAlex.
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- Application of norepinephrine in the treatment of septic shock: a meta-analysis.Irish journal of medical science · 2025Pooled it
- Early management of adult sepsis and septic shock: Korean clinical practice guidelines.Acute and critical care · 2024Guideline
- Norepinephrine in Septic Shock: A Systematic Review and Meta-analysis.The western journal of emergency medicine · 2021Pooled it
- [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020Guideline
- Comparative efficacy of vasoactive medications in patients with septic shock: a network meta-analysis of randomized controlled trials.Critical care (London, England) · 2019Pooled it
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.Intensive care medicine · 2017Guideline
- Vasopressors for hypotensive shock.The Cochrane database of systematic reviews · 2016Pooled it
- Pooled it
- Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012.Intensive care medicine · 2013Guideline
- Pharmacologic agents for acute hemodynamic instability: recent advances in the management of perioperative shock- a systematic review.Annals of cardiac anaesthesiaPooled it
- Effect of continuous intraoperative infusion of methoxamine on renal function in elderly patients undergoing gastrointestinal tumor surgery: a randomized controlled trial.BMC anesthesiology · 2020Trial
- Terlipressin as a rescue therapy for catecholamine-resistant septic shock in children.Intensive care medicine · 2008Trial
- Renal effects of low-dose dopamine in patients with sepsis syndrome or septic shock treated with catecholamines.Intensive care medicine · 1996Trial
- Optimizing Timing and Dose of Starting Norepinephrine and Vasopressin in Septic Shock.Life (Basel, Switzerland) · 2026Review
- Initial fluid resuscitation in septic shock: Reassessing the 30 mL/kg paradigm.Journal of intensive medicine · 2025Article
- Norepinephrine Versus Dopamine as a First-Line Vasopressor in Dogs with Hypotension: A Pilot Study.Veterinary sciences · 2025Article
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024.Journal of intensive care · 2025Article
- Molecular Basis of Na, K-ATPase Regulation of Diseases: Hormone and FXYD2 Interactions.International journal of molecular sciences · 2024Review
- Linear Correlation Between Mean Arterial Pressure and Urine Output in Critically Ill Patients.Critical care explorations · 2024Observational
22 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
STUDY
objectiveTo compare the ability of dopamine and norepinephrine to reverse hemodynamic and metabolic abnormalities of human hyperdynamic septic shock.
designProspective, double-blind, randomized trial.
settingAn ICU in a university hospital. PATIENTS: Adult patients with hyperdynamic septic shock after fluid resuscitation.
interventionsPatients were assigned to receive either dopamine (2.5 to 25 micrograms/kg/min) or norepinephrine (0.5 to 5.0 micrograms/kg/min). If hemodynamic and metabolic abnormalities were not corrected with the maximum dose of one drug, the other was added. MEASUREMENTS AND
resultsThe aim of therapy was to achieve and maintain for at least 6 h all of the following: (1) systemic vascular resistance index > 1,100 dynes.s/cm5.m2 and/or mean systemic blood pressure > or = 80 mm Hg; (2) cardiac index > or = 4.0 L/min/m2; (3) oxygen delivery > 550 ml/min/m2; and (4) oxygen uptake > 150 ml/min/m2. With the use of dopamine 10 to 25 micrograms/kg/min, 5 of 16 patients (31 percent) were successfully treated, as compared with 15 of 16 patients (93 percent) by norepinephrine at a dose of 1.5 +/- 1.2 micrograms/kg/min (p < 0.001). Ten of 11 patients who did not respond to dopamine and remained hypotensive and oliguric were successfully treated with the addition of norepinephrine.
conclusionsAt the doses tested, norepinephrine was found, in the present study, to be more effective and reliable than dopamine to reverse the abnormalities of hyperdynamic septic shock. In the great majority of the study patients, norepinephrine was able to increase mean perfusing pressure without apparent adverse effect on peripheral blood flow or on renal blood flow (since urine flow was reestablished). At the same time, oxygen uptake was increased.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.