Intraoperative Dobutamine Plus Norepinephrine to Prevent Postoperative Acute Kidney Injury in Septic Shock: A Randomized Clinical Trial
JAMA, 2026 · Open-label randomized trial in 39 Chinese hospitals, 584 patients
What the trial found
AKI occurred in 22.8% versus 34.7% (adjusted RR 0.64, 95% CI 0.49–0.83); tachycardia was more frequent with dobutamine.
Current guideline position
This trial must be interpreted alongside indication-specific guidance; its result alone does not establish a universal treatment policy.
Clinical interpretation
A setting-specific AKI result does not justify routine dobutamine in all septic shock or establish a survival benefit.
Limitations
The subset of sepsis with profound circulatory and cellular/metabolic abnormality — clinically identified by a vasopressor requirement to maintain MAP ≥ 65 mmHg plus lactate > 2 mmol/L despite adequate fluid resuscitation.
Sepsis-AKI microcirculatory decoupling, KDIGO staging, Furosemide Stress Test (FST), urine microscopy, and the AEIOU dialysis threshold framework.
Systematic postoperative ICU surveillance for bleeding, respiratory failure, myocardial injury, AKI, delirium, infection, pain, nutrition and safe device removal.
ICU approach to perforation, abscess, postoperative leak, ischemic bowel and complicated intra-abdominal infection