Which first-line vasoactive drug is the best choice for children with fluid-refractory septic shock? A prospective, randomized, blinded study of 120 children compared dopamine versus epinephrine in attempts to answer this debated question in the current guidelines for pediatric sepsis.
Bottom line: Dopamine was associated with an increased risk of death and healthcare–associated infection. Early administration of peripheral or intraosseous epinephrine was associated with increased survival in this population.
Answer
This was a small double-blind, prospective randomized controlled trial of 120 children with fluid-refractory septic shock in a PICU in Brazil. The primary outcome was to compare the effects of dopamine or epinephrine in severe sepsis on 28-day mortality; secondary outcomes were the rate of healthcare–associated infection, the need for other vasoactive drugs, and the multiple organ dysfunction score. Dopamine was associated with death (OR, 6.5; 95% CI, 1.1–37.8; p = 0.037) and healthcare–associated infection (odds ratio, 67.7; 95% CI, 5.0–910.8; p = 0.001). The use of epinephrine was associated with a survival odds ratio of 6.49. Further multicenter trials or single-center studeis are necessary to verify the reproducibiltiy of these results.
