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Vasopressin for treatment of vasodilatory shock: an ESICM systematic review and meta-analysis

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Abstract

Objective

To examine the benefits and risks of vasopressin or its analog terlipressin for patients with vasodilatory shock.

Data source

We searched the CENTRAL, MEDLINE, EMBASE, and LILACS databases (up to March 2011) as well as reference lists of articles and proceedings of major meetings; we also contacted trial authors. We considered randomized and quasirandomized trials of vasopressin or terlipressin versus placebo or supportive treatment in adult and pediatric patients with vasodilatory shock. The primary outcome for this review was short-term all-cause mortality.

Study selection

We identified 10 randomized trials (1,134 patients). Six studies were considered for the main analysis on mortality in adults.

Data extraction and synthesis

The crude short-term mortality was 206 of 512 (40.2%) in vasopressin/terlipressin-treated patients and 198 of 461 (42.9%) in controls [six trials, risk ratio (RR) = 0.91; 95% confidence interval (CI) 0.79–1.05; P = 0.21; I 2 = 0%]. There were 49 of 463 (10.6%) patients with serious adverse events in the vasopressin/terlipressin arm and 51 of 431 (11.8%) in the control arm (four trials, RR = 0.90; 95% CI 0.49–1.67; P = 0.75; I 2 = 26%). Metaregression analysis showed negative correlation between vasopressin dose and norepinephrine dose (P = 0.03).

Conclusions

Overall, use of vasopressin or terlipressin did not produce any survival benefit in the short term in patients with vasodilatory shock. Physicians may value the sparing effects of vasopressin/terlipressin on norepinephrine requirement given its apparent safe profile.

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Correspondence to Angelo Polito.

Additional information

On behalf of the ESICM Systematic Review Group (http://www.esicm.org/Data/ModuleGestionDeContenu/PagesGenerees/05-research/0D-trialsgroup/168.asp).

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Appendix

Appendix

The ESICM Systematic Review Group was established in 2010 to provide an international collaboration focused on critical care systematic reviews. Its primary goals are to highlight the role of systematic reviews (SR) and meta-analyses (MA) in clinical research and to facilitate access to high-quality SRs and MAs for practicing clinicians, thereby promoting use of evidence-based medicine. It is the first intensive or critical care medicine society to provide its members, patients, public health authorities, and the general public with an organized database of systematic reviews and diagnostic interventions pertaining to intensive care. The Unit Board is composed by Djillali Annane (Chair) and Mark Hamilton (Deputy).

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Polito, A., Parisini, E., Ricci, Z. et al. Vasopressin for treatment of vasodilatory shock: an ESICM systematic review and meta-analysis. Intensive Care Med 38, 9–19 (2012). https://doi.org/10.1007/s00134-011-2407-x

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  • DOI: https://doi.org/10.1007/s00134-011-2407-x

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