I am sorry to say but this is not an accurate statement. Dopamine through plenty of studies has been shown to be associated with an increased mortality. The Surviving Sepsis Campaign being a valid one in and of itself. I do not believe that any single person on this forum is educated or experienced enough to speak against the recommendations of a committee of MD's whose sole commitment has been to research, test, and study the treatment of sepsis. Your statements are dogmatic..
Well first, I did not "speak against" any recommendations. Never did I say that the surviving sepsis guidelines were wrong or that they shouldn't be followed. I simply said that
to my understanding, the strength of the data supporting norepi over dopamine was not overwhelming. I even wrote "but I've been wrong before" to indicate that I wasn't 100% sure about that. I read the 2016 guidelines when they came out and I'm pretty familiar with them, but as someone who doesn't manage patients in the unit, I don't make it a big priority to stay up-to-the minute on all the nitty gritty details.
Then after you called me out here, I went back and reviewed the section of the
guidelines that discusses vasopressors. Turned out I was right after all. On page 19 of the guidelines, under Section G, "Vasoactive Medications", the very first line says "We recommend norepinephrine as the first choice vasopressor (strong recommendation, moderate quality of evidence). I briefly looked at the
meta analysis that this recommendation is based on, and without getting to far into the weeds discussing the studies in the meta-analysis, suffice it to say that it's pretty clear why the authors of the study describe the quality of evidence as "moderate" rather than "high". Don't confuse quantity of evidence with quality of evidence.
Second, the guidelines themselves are not evidence. They are a consensus document formed from the
opinions of a group of clinicians from various backgrounds (most of whom are NOT researchers themselves, as you claim), many of which may not even agree all that strongly with certain parts of the final recommendations. I happen to think the Surviving Sepsis guidelines are pretty solid (I think all of the SCCM's recommendations are about as good as they come), but don't forget that it was "the experts" who used to tell us that high-dose epi was good for cardiac arrests, that backboards should be used on all trauma patients, that bleeding patients should receive enough IVF to raise their BP to a near normal level, that everyone should get high-flow oxygen, and that 10-15 ml/kg was a good tidal volume. We could go on and on with stuff that "experts" have been wrong about.
Lastly, I doubt that there is any evidence at all that the choice of vasopressor in the prehospital phase affects eventual outcomes, certainly not large, high-quality studies. Unless that data does in fact exist, you can't make the claim that using dopamine prehospital for sepsis has any impact.
Your statements are dogmatic..
Skepticism is actually the opposite of dogma. Don't blindly accept everything that you read or are told. Look it up and evaluate the the validity and importance for yourself. Be a clinician, not a drone.
