Some guidelines recommend either dopamine or epinephrine for fluid-refractory septic shock, but a study by Ventura et al. (click here) looked to see if one was superior to the other as a first-line pressor

In a double-blind, prospective, randomized controlled trial, the authors randomized patients to receive either dopamine (5–10 μg/kg/min) or epinephrine (0.1–0.3 μg/kg/min) if they continued to show signs of tissue hypoperfusion after two 20 cc/kg fluid boluses.

The primary outcome was death by any cause after 28 days, and the study was stopped prematurely after 121 (of initially planned 180) patients underwent randomization because of mortality difference.

The mortality was 13 (20.6%) in the dopamine group and four (7%) in the epinephrine group (p = 0.033).

Secondary outcomes of healthcare-associated infections (HAI), need for other pressors and multiple organ dysfunction score was significant only for increased HAI with dopamine.

Limitations: single center study in Brazil, decision to start and stop pressors based on subjective clinical judgment, and did not stratify between cold and warm shock.