The International Sepsis Forum's controversies in sepsis: my initial vasopressor agent in septic shock is norepinephrine rather than dopamine

Vasopressor agents are often used in patients with septic shock when aggressive fluid resuscitation fails to correct hypotension. Dopamine and norepinephrine are two such vasopressor agents. In the past, fear of potential excessive vasoconstriction, with resultant end-organ hypoperfusion, restricted the use of norepinephrine in septic shock, relegating it to a second-line agent. However, recent data suggest that this relegation is unmerited and that norepinephrine may even be superior to dopamine in some respects, and should be considered as the preferred first-line agent. In the present commentary we review the evidence supporting the use of norepinephrine as the agent of choice in the treatment of septic shock.