Intraoperative Drug Combination Reduces Kidney Injury in Septic Shock Surgery

Although emergency surgery can clear the underlying infection, inflammation and surgical trauma may continue to threaten kidney function. New findings suggest that adjusting drug therapy during surgery may help reduce this risk by lowering the incidence of acute kidney injury in these high-risk patients

Scientists from the University of Southampton and Zhejiang University School of Medicine evaluated the combined use of dobutamine and norepinephrine during surgery in patients with septic shock. Norepinephrine supports blood pressure, while dobutamine is a heart medication that improves blood flow. By combining these effects, the approach aims to support circulation and reduce the risk of inadequate blood supply to the kidneys.

The trial followed 584 adult patients undergoing surgery across 39 hospitals in China. Half of the patients received an infusion of dobutamine with norepinephrine. The comparison group received norepinephrine alone. The findings were published in JAMA under the title “Intraoperative Dobutamine Plus Norepinephrine to Prevent Postoperative Acute Kidney Injury in Septic Shock.”

Fewer than one-quarter of patients who received the drug combination developed new or worsening kidney injury within one week after surgery. In the norepinephrine-only group, the rate was around 35%. The combination was also associated with more frequent temporary tachycardia, which affected 41% of patients compared with about 30% in the standard care group. Researchers reported no increase in serious complications such as cardiac arrest or arrhythmias.

The investigators also reported that the therapy appeared most effective against more serious kidney injury. Moderate to severe kidney injuries were roughly halved among patients who received both drugs. These patients also produced more urine immediately and showed milder overall signs of organ strain during the first day in intensive care.

“Our trial discovered that adding these two heart medications during the operation safely boosts blood flow. It also significantly cuts the risk of severe kidney damage, offering a safer way to protect vulnerable patients during high-risk surgery,” said Dr. Nazrul Islam from Southampton, senior co-corresponding author.

“Our research is timely as the International Guidelines for Management of Sepsis and Septic Shock recently said there was insufficient data to make a recommendation for the use of dobutamine. Clearly this can now be changed—and we hope our findings can help doctors rethink how they care for patients during high-risk emergency surgery,” said Dr. Xiangming Fang, primary corresponding author from Zhejiang University School of Medicine.

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University of Southampton
Zhejiang University School of Medicine