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What's the best vasopressor in septic shock?

Report by: Amery Robinson, Emergency Medicine Resident

Search checked by: Jeffrey Jones, Research Director, EM Residency Program

Institution: Grand Rapids Medical Education and Research Center, Grand Rapids, Michigan, USA

Three-part question

For [adult patients presenting to the emergency department or the intensive care unit] do [epinephrine, dopamine, dobutamine, or vasopressin] produce better [28 and 90 day mortality rates] than norepinephrine alone?

Clinical scenario

A 74-year-old female presents from a nursing home with altered mental status and recent diagnosis of pneumonia. She is febrile, tachypnoeic, tachycardic, anuric, and has a blood pressure of 72/35. Your attending physician suggests you start her on an infusion of norepinephrine; however, epinephrine has more inotropic effect. You wonder what is the best vasopressor for your patient?

Search strategy

Medline 1950—3/10 using Ovid interface, Cochrane Library (2010), PubMed clinical queries

[(exp shock, septic/drug therapy) AND (exp vasocontrictor agents or vasopressors.mp)] Limit to human and English.

Search outcome

Trials were excluded if they were not designed to investigate mortality but rather surrogate measures such as blood pressure and cardiac index. A total of …

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