Intraoperative Dobutamine Plus Norepinephrine Cuts Postoperative AKI in Septic Shock Surgery
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A randomized clinical trial published in JAMA tested whether adding dobutamine (up to 5 µg/kg/min) to norepinephrine during surgery protects the kidneys of adults in septic shock undergoing surgical source control. Across 39 tertiary hospitals in China, 22.8% (66/290) of patients on the combination developed acute kidney injury within 7 days, versus 34.7% (102/294) on norepinephrine alone, with an adjusted risk ratio of 0.64 (95% CI, 0.49-0.83). Stage 2 and 3 AKI were also less frequent with the combination, though tachycardia occurred more often. The trial supplies randomized evidence for a practice previously supported only by very low-certainty evidence. The trade-off with tachycardia and applicability beyond the studied setting remain open questions.
Written by a model from the reports · updated 2 hours ago
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- JAMAPickIntraoperative Dobutamine Plus Norepinephrine to Prevent Postoperative Acute Kidney Injury in Septic Shock: A Randomized Clinical Trial.
Intraoperative dobutamine (up to 5 µg/kg/min) plus norepinephrine reduced postoperative acute kidney injury within 7 days in adults with septic shock undergoing surgical source control: AKI occurred in 22.8% (66/290) with the combination vs 34.7% (102/294) with norepinephrine alone (adjusted risk ratio 0.64 [95% CI, 0.49-0.83]). Stage 2 and 3 AKI were also lower, though tachycardia was more frequent. The trial, conducted in 39 tertiary hospitals in China, provides randomized evidence for a guideline recommendation previously based on very low-certainty evidence.
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