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Norepinefrina más dobutamina versus epinefrina sola para el manejo del shock séptico: un ensayo aleatorizado
Djillali Annane1, Philippe Vignon, Alain Renault
1Raymond Poincaré Hospital (AP-HP), University of Versailles Saint Quentin, PRES UniverSud, Paris, France. djillali.annane@rpc.aphp.fr
Lancet (London, England)
|August 28, 2007
Resumen
En el manejo del shock séptico, la epinefrina sola mostró una eficacia y seguridad similares en comparación con la norepinefrina más dobutamina. Este gran ensayo no encontró diferencias significativas en la mortalidad a los 28 días entre las dos estrategias de tratamiento.
Área de la Ciencia:
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Farmacología Farmacología.
- Los ensayos clínicos son ensayos clínicos.
Sus antecedentes:
- Las pautas internacionales sugieren la norepinefrina o la dopamina sobre la epinefrina para el shock séptico.
- No hay grandes ensayos comparativos que hayan evaluado directamente la epinefrina frente a la norepinefrina más dobutamina.
Objetivo del estudio:
- Para comparar la eficacia y seguridad de la norepinefrina más dobutamina con epinefrina sola en pacientes con shock séptico.
Principales métodos:
- Un estudio prospectivo, multicéntrico, aleatorizado y doble ciego que involucró a 330 pacientes con shock séptico en 19 UCI francesas.
- Los pacientes recibieron epinefrina o norepinefrina más dobutamina, titulados para mantener la presión arterial media ≥70 mm Hg.
- El resultado primario fue la mortalidad por cualquier causa a los 28 días; se realizó un análisis de intención de tratar.
Principales resultados:
- No hay diferencia significativa en la mortalidad por cualquier causa a los 28 días: 40% en el grupo de epinefrina frente a 34% en el grupo de norepinefrina más dobutamina (p=0,31).
- Tasas similares de mortalidad en el alta de cuidados intensivos, el alta hospitalaria y el día 90 entre los grupos.
- No se observaron diferencias significativas en el tiempo hasta el éxito hemodinámico, la retirada de vasopresores o la progresión de la puntuación SOFA; los eventos adversos graves también fueron comparables.
Conclusiones:
- La epinefrina sola y la norepinefrina más dobutamina demuestran una eficacia y seguridad comparables en el manejo del shock séptico.
- El estudio no proporciona evidencia para favorecer una estrategia de tratamiento sobre la otra para el manejo del shock séptico.
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