We conducted this multicenter trial between December 19, 2003, and October 6, 2007, in eight centers in Belgium, Austria, and Spain. All patients 18 years of age or older in whom a vasopressor agent was required for the treatment of shock were included in the study. The patient was considered to be in shock if the mean arterial pressure was less than 70 mm Hg or the systolic blood pressure was less than 100 mm Hg despite the fact that an adequate amount of fluids (at least 1000 ml of crystalloids or 500 ml of colloids) had been administered (unless there was an elevation in the central venous pressure to >12 mm Hg or in pulmonary-artery occlusion pressure to >14 mm Hg) and if there were signs of tissue hypoperfusion (e.g., altered mental state, mottled skin, urine output of <0.5 ml per kilogram of body weight for 1 hour, or a serum lactate level of >2 mmol per liter). Patients were excluded if they were younger than 18 years of age; had already received a vasopressor agent (dopamine, norepinephrine, epinephrine, or phenylephrine) for more than 4 hours during the current episode of shock; had a serious arrhythmia, such as rapid atrial fibrillation (>160 beats per minute) or ventricular tachycardia; or had been declared brain-dead.
Thus, dopamine and norepinephrine may have different effects on the kidney, the splanchnic region, and the pituitary axis, but the clinical implications of these differences are still uncertain. Consensus guidelines and expert recommendations suggest that either agent may be used as a first-choice vasopressor in patients with shock.6-8 However, observational studies have shown that the administration of dopamine may be associated with rates of death that are higher than those associated with the administration of norepinephrine.3,9,10 The Sepsis Occurrence in Acutely Ill Patients (SOAP) study,3 which involved 1058 patients who were in shock, showed that administration of dopamine was an independent risk factor for death in the intensive care unit (ICU). In a meta-analysis,11 only three randomized studies, with a total of just 62 patients, were identified that compared the effects of dopamine and norepinephrine in patients with septic shock. The lack of data from clinical trials in the face of growing observational evidence that norepinephrine may be associated with better outcomes called for a randomized, controlled trial. Our study was designed to evaluate whether the choice of norepinephrine over dopamine as the first-line vasopressor agent could reduce the rate of death among patients in shock.
Try calf raises for an easy way to exercise your calves. In a standing position, push on the balls of your feet while raising your heels so that you’re standing on your toes. Hold this position for 1-3 seconds, then slowly lower yourself back down to starting position. Do 10 reps, or as many as you can, and do as many sets as needed to complete 30 reps overall.