Comparative Study of Using Norepinephrine Infusion versus Dopamine in Hemodynamically Unstable Patients at Surgical Intensive Care Unit

Objective: This study evaluated the efficacy and safety of norepinephrine infusion versus dopamine in managing hemodynamically unstable patients in the surgical intensive care unit.

Methodology: This retrospective cohort study was conducted on patients admitted during 2021 and 2022. It was conducted at Peoples Medical College Hospital, Shaheed Benzirabad, Pakistan. The study included patients with hemodynamic instability, hypotension, and impaired tissue perfusion. The standardized protocol guided the administration of norepinephrine and dopamine, with doses adjusted according to hemodynamic goals and patient response.

Results: Patient records of 399 met the study criteria after reviewing the records. Among non-operative cases, 12.28% (n=49) patients received norepinephrine, while 46.37% (n=185) received dopamine. In post-operative cases, 6.27% (n=25) patients were administered norepinephrine compared to 35.08% (n=140) who received dopamine. In norepinephrine patients, 14.01% (n=16) were on self-ventilation, and 3.26% (n=13) required mechanical ventilation post-operatively, whereas, in the dopamine group, 8.77% (n=35) patients were on self-ventilation and 26.31% (n=105) on mechanical ventilation. Non-operative norepinephrine patients showed 7.02% (n=28) self-ventilation and 4.26% (n=17) mechanical ventilation, while dopamine patients showed 23.81% (n=95) self-ventilation and 22.56% (n=90) mechanical ventilation. Antibiotic use was higher in the dopamine group (76.19%, n=304) compared to the norepinephrine group (17.29%, n=69). Mortality was lower with norepinephrine (64.89%, n=48) than with dopamine (75.1%, n=244).

Conclusion: These results suggest that norepinephrine may be more effective and safer than dopamine, supporting its use as a first-line vasopressor.