Dobutamine during source-control surgery in septic shock

Design

Randomised, open-label trial at 39 hospitals

Population

584 adults with septic shock undergoing surgical source control

Primary outcome

New or worsening AKI (KDIGO) within 7 days

Effect

22.8% vs 34.7%; adjusted RR 0.64 (95% CI 0.49–0.83)

A trial in JAMA (14 October) randomised 584 adults with septic shock having surgery to control the source of infection, at 39 Chinese hospitals, to low-dose dobutamine (up to 5 µg/kg/min) plus norepinephrine or norepinephrine alone during the operation.

New or worsening acute kidney injury (AKI) within seven days occurred in 22.8% with dobutamine and 34.7% without — an adjusted risk ratio of 0.64. Stage 2 and stage 3 AKI were both less frequent, organ-failure scores on day one were slightly lower and urine output slightly higher. Nine of eleven secondary outcomes showed no difference, and tachycardia was more common with dobutamine.

Current sepsis guidance supports dobutamine only for cardiac dysfunction with persistent hypoperfusion, on very weak evidence. This trial tested it more broadly, during surgery only, and in an open-label design. It is a reason for anaesthetists and intensivists to discuss the approach, not yet a reason to change protocols on one trial.

• Low-dose dobutamine was added only during the operation, capped at 5 µg/kg/min
• Watch heart rate: tachycardia was more frequent with dobutamine
• Sepsis guidelines have not changed; dobutamine remains advised for low cardiac output with poor perfusion
• The primary outcome was kidney injury, not survival

Why it matters

It is the first randomised evidence on a drug sepsis guidelines recommend on very low-certainty grounds.

Don't overread it

Open-label, one country, and kidney injury is not mortality — it needs replication before routine use.

The statistics, in plain English

An adjusted risk ratio of 0.64 (95% CI 0.49 to 0.83) means about a third fewer AKI cases; in absolute terms, about one case prevented for every eight or nine patients treated. Because neither team nor patients were blinded, judgement-dependent care decisions could have influenced kidney outcomes.

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