A total of 5 observational studies and 6 randomized controlled trials, totaling 2,769 patients, were evaluated. In the observational studies, no difference in mortality was identified but significant heterogeneity existed. In the trial by Povoa et al, patients who received both dopamine and norepi-nephrine were counted twice, yielding more septic shock patients than were included in the entire study, introducing a high risk of bias. This trial was deemed responsible for the substantial heterogeneity, and after its exclusion, dopamine was associated with an increase in mortality compared with norepinephrine (Table). Among the randomized controlled trials, dopamine was associated with an increased risk of death and arrhythmias.
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