Pressors in Peds, by Dr. Grace Lam

  • 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.