From the Guidelines
Dopamine should not be used in the treatment of a septic patient. While vasopressin, epinephrine, and norepinephrine are all acceptable vasopressors for septic shock, dopamine has fallen out of favor due to its association with increased mortality and arrhythmias compared to other agents. Current sepsis guidelines recommend norepinephrine as the first-line vasopressor, with vasopressin or epinephrine as appropriate second-line options, as stated in the Surviving Sepsis Campaign guidelines 1.
Key Points
- Dopamine's mixed effects on dopaminergic, beta-adrenergic, and alpha-adrenergic receptors make its hemodynamic effects less predictable, and at higher doses, it can cause excessive tachycardia and myocardial oxygen demand.
- Additionally, dopamine may suppress immune function and pituitary hormone secretion, which could be detrimental in sepsis.
- The guidelines suggest using dopamine as an alternative vasopressor agent to norepinephrine only in highly selected patients (e.g., patients with low risk of tachyarrhythmias and absolute or relative bradycardia) 1.
- The most recent and highest quality study recommends against using low-dose dopamine for renal protection (strong recommendation, high quality of evidence) 1. For these reasons, dopamine should be avoided in septic patients unless other vasopressors are unavailable. The use of norepinephrine, vasopressin, or epinephrine is preferred due to their more predictable hemodynamic effects and lower risk of adverse events, as supported by the guidelines 1.
From the Research
Vasopressor Options for Septic Patients
The following vasopressors are commonly used in the treatment of septic patients:
- Vasopressin
- Dopamine
- Epinephrine
- Norepinephrine
Recommendations Based on Studies
According to the studies, dopamine is associated with a higher risk of adverse events, such as cardiac arrhythmias, compared to norepinephrine 2, 3, 4, 5. The study by 6 also suggests that dopamine is associated with a higher risk of 28-day mortality due to septic shock than norepinephrine, terlipressin, and vasopressin.
Vasopressor to Avoid
Based on the evidence, dopamine should not be used as the first-line vasopressor in the treatment of septic patients due to its association with increased adverse events and mortality 2, 3, 4, 6, 5. Norepinephrine is recommended as the first-line vasopressor in septic shock patients 2, 4, 5.