Controversies regarding choice of vasopressor therapy for management of septic shock in animals.

OBJECTIVE: To review and appraise common vasopressor drugs used to treat septic shock-induced hypotension in volume replete animals.

DATA SOURCES: Human and animal publications were searched using PubMed without time limits and the following keywords were used: "vasopressor," "septic shock," "norepinephrine," "dopamine," "epinephrine," and "vasopressin."

HUMAN DATA SYNTHESIS: The choice of vasopressor drug is unlikely to have a marked impact on outcome, but the incidence of adverse events (eg, tachycardia) varies greatly between the various treatment options. In agreement with the 2012 Cochrane Database consensus, norepinephrine is the first-choice vasopressor to maintain a mean arterial pressure ≥65 mm Hg. If an additional agent is required, epinephrine should be administered. Low-dose vasopressin can be added to norepinephrine to either increase the arterial blood pressure to the target goal value or decrease the norepinephrine dose, but should not be used as the initial vasopressor. Dopamine is not recommended except in highly selected circumstances.

VETERINARY DATA SYNTHESIS: There is insufficient evidence to make definitive conclusions regarding the treatment of naturally occurring septic shock, but clinical studies are underway to provide further data.

CONCLUSIONS: The treatment of hypotension in people or animals with septic shock is challenging and vasopressor therapy is associated with a variety of adverse effects. Further research is warranted in dogs and cats to establish evidence-based guidelines.