Adding Dobutamine to Norepinephrine Cuts AKI After Septic Shock Source Control

In adults with septic shock undergoing surgical source control, adding intraoperative dobutamine to norepinephrine reduced new-onset or worsening acute kidney injury (AKI) within 7 days after surgery, compared with norepinephrine alone. The findings come from a randomized clinical trial published online in JAMA.

The investigators noted that international guidelines recommend dobutamine for adults with septic shock and cardiac dysfunction with persistent hypoperfusion, but that the recommendation rests on very low–certainty evidence. They also noted a lack of randomized trials of the combination in patients undergoing surgical source control. The open-label trial enrolled adults at 39 tertiary hospitals in China between June 2024 and August 2025. Patients received either intraoperative intravenous dobutamine (up to 5µg/kg/min) plus norepinephrine or norepinephrine alone. The Ministry of Education of China and the National Natural Science Foundation of China funded the trial.

The primary outcome was new-onset AKI or worsening of preoperative AKI within 7 days after surgery, defined by Kidney Disease: Improving Global Outcomes criteria. The trial included 584 patients (median age, 67.5 years; 32.9% female). The primary outcome occurred in 22.8% of the dobutamine plus norepinephrine group and 34.7% of the norepinephrine group.

Nine of 11 secondary outcomes did not differ significantly between groups. With dobutamine plus norepinephrine, Sequential Organ Failure Assessment scores on postoperative day 1 were lower and urine output 1 hour after the intervention was higher. Mortality at day 28 did not differ significantly (16.2% vs 20.4%). Tachycardia was more common with dobutamine plus norepinephrine (41.0% vs 29.9%). Other safety outcomes, including ventricular tachycardia and cardiac arrest, were similar.

The authors listed several limitations. The open-label design may introduce bias, the intervention was limited to the intraoperative period, and the findings may not apply to medical septic shock. The trial was also not designed to compare dobutamine with other inotropic agents.

Source: Chinese Perioperative Septic Shock Investigators for the Chinese Peri-Operative Organ Protection Group. Intraoperative dobutamine plus norepinephrine to prevent postoperative acute kidney injury in septic shock: a randomized clinical trial. JAMA. Published online October 14, 2026. doi:10.1001/jama.2026.21322