Intensive Care Medicine

, Volume 38, Issue 1, pp 9-19

First online:

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

  • Angelo PolitoAffiliated withDepartment of Cardiology, Bambino Gesù Children’s Hospital Email author 
  • , Emilio ParisiniAffiliated withCenter for Nano Science and Technology@POLIMI, Istituto Italiano di Tecnologia
  • , Zaccaria RicciAffiliated withDepartment of Cardiology, Bambino Gesù Children’s Hospital
  • , Sergio PicardoAffiliated withDepartment of Cardiology, Bambino Gesù Children’s Hospital
  • , Djillali AnnaneAffiliated withCritical Care Department, Hôpital Raymond Poincaré (Assistance Publique-Hôpitaux de Paris), University of Versailles

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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).


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.


Vasopressin Terlipressin Vasodilatory shock