Intensive Care Medicine

, Volume 38, Issue 1, pp 9–19

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

  • Angelo Polito
  • Emilio Parisini
  • Zaccaria Ricci
  • Sergio Picardo
  • Djillali Annane
Review

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; I2 = 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; I2 = 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.

Keywords

Vasopressin Terlipressin Vasodilatory shock 

Supplementary material

134_2011_2407_MOESM1_ESM.doc (374 kb)
Supplementary material 1 (DOC 374 kb)
134_2011_2407_MOESM2_ESM.doc (92 kb)
Supplementary material 2 (DOC 92 kb)

References

  1. 1.
    Landry DW, Oliver JA (2001) The pathogenesis of vasodilatory shock. N Engl J Med 345:588–595PubMedCrossRefGoogle Scholar
  2. 2.
    Annane D, Aegerter P, Jars-Guincestre MC, Guidet B (2003) Current epidemiology of septic shock: the CUB-Rea network. Am J Respir Crit Care Med 168:165–172PubMedCrossRefGoogle Scholar
  3. 3.
    Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36:296–327PubMedCrossRefGoogle Scholar
  4. 4.
    Antonelli M, Azoulay E, Bonten M, Chastre J, Citerio G, Conti G, De Backer D, Lemaire F, Gerlach H, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Pugin J, Wernerman J, Zhang H (2010) Year in review in intensive care medicine 2009:II. Neurology, cardiovascular, experimental, pharmacology and sedation, communication and teaching. Intensive Care Med 36:412–427PubMedCrossRefGoogle Scholar
  5. 5.
    Landry DW, Levin HR, Gallant EM, Ashton RC Jr, Seo S, D’Alessandro D, Oz MC, Oliver JA (1997) Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation 95:1122–1125PubMedGoogle Scholar
  6. 6.
    Mutlu GM, Factor P (2004) Role of vasopressin in the management of septic shock. Intensive Care Med 30:1276–1291PubMedGoogle Scholar
  7. 7.
    Sharshar T, Blanchard A, Paillard M, Raphael JC, Gajdos P, Annane D (2003) Circulating vasopressin levels in septic shock. Crit Care Med 31:1752–1758PubMedCrossRefGoogle Scholar
  8. 8.
    Dunser MW, Hasibeder WR, Wenzel V, Schwarz S, Ulmer H, Knotzer H, Pajk W, Friesenecker BE, Mayr AJ (2004) Endocrinologic response to vasopressin infusion in advanced vasodilatory shock. Crit Care Med 32:1266–1271PubMedCrossRefGoogle Scholar
  9. 9.
    Dunser MW, Mayr AJ, Ulmer H, Knotzer H, Sumann G, Pajk W, Friesenecker B, Hasibeder WR (2003) Arginine vasopressin in advanced vasodilatory shock: a prospective, randomized, controlled study. Circulation 107:2313–2319PubMedCrossRefGoogle Scholar
  10. 10.
    Holmes CL, Walley KR, Chittock DR, Lehman T, Russell JA (2001) The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series. Intensive Care Med 27:1416–1421PubMedCrossRefGoogle Scholar
  11. 11.
    Landry DW, Levin HR, Gallant EM, Seo S, D’Alessandro D, Oz MC, Oliver JA (1997) Vasopressin pressor hypersensitivity in vasodilatory septic shock. Crit Care Med 25:1279–1282PubMedCrossRefGoogle Scholar
  12. 12.
    Asfar P, De Backer D, Meier-Hellmann A, Radermacher P, Sakka SG (2004) Clinical review: influence of vasoactive and other therapies on intestinal and hepatic circulations in patients with septic shock. Crit Care 8:170–179PubMedCrossRefGoogle Scholar
  13. 13.
    Klinzing S, Simon M, Reinhart K, Bredle DL, Meier-Hellmann A (2003) High-dose vasopressin is not superior to norepinephrine in septic shock. Crit Care Med 31:2646–2650PubMedCrossRefGoogle Scholar
  14. 14.
    Martikainen TJ, Tenhunen JJ, Uusaro A, Ruokonen E (2003) The effects of vasopressin on systemic and splanchnic hemodynamics and metabolism in endotoxin shock. Anesth Analg 97:1756–1763PubMedCrossRefGoogle Scholar
  15. 15.
    Russell JA, Walley KR, Singer J, Gordon AC, Hebert PC, Cooper DJ, Holmes CL, Mehta S, Granton JT, Storms MM, Cook DJ, Presneill JJ, Ayers D (2008) Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 358:877–887PubMedCrossRefGoogle Scholar
  16. 16.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097PubMedCrossRefGoogle Scholar
  17. 17.
    Devereaux PJ, Manns BJ, Ghali WA, Quan H, Lacchetti C, Montori VM, Bhandari M, Guyatt GH (2001) Physician interpretations and textbook definitions of blinding terminology in randomized controlled trials. JAMA 285:2000–2003PubMedCrossRefGoogle Scholar
  18. 18.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12PubMedCrossRefGoogle Scholar
  19. 19.
    RM (RevMan) (2008) Version 5.0 Nordic Cochrane center. Cochrane collaboration, Copenhagen, DenmarkGoogle Scholar
  20. 20.
    Borenstein MHL, Higgins J, Rothstein H (2005) Comprehensive meta-analysis version 2. Biostat, EnglewoodGoogle Scholar
  21. 21.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRefGoogle Scholar
  22. 22.
    Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101PubMedCrossRefGoogle Scholar
  23. 23.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedCrossRefGoogle Scholar
  24. 24.
    Choong K, Bohn D, Fraser DD, Gaboury I, Hutchison JS, Joffe AR, Litalien C, Menon K, McNamara P, Ward RE (2009) Vasopressin in pediatric vasodilatory shock: a multicenter randomized controlled trial. Am J Respir Crit Care Med 180:632–639PubMedCrossRefGoogle Scholar
  25. 25.
    Lauzier F, Levy B, Lamarre P, Lesur O (2006) Vasopressin or norepinephrine in early hyperdynamic septic shock: a randomized clinical trial. Intensive Care Med 32:1782–1789PubMedCrossRefGoogle Scholar
  26. 26.
    Malay MB, Ashton RC, Jr., Landry DW, Townsend RN (1999) Low-dose vasopressin in the treatment of vasodilatory septic shock. J Trauma 47:699-703; discussion 703-695Google Scholar
  27. 27.
    Patel BM, Chittock DR, Russell JA, Walley KR (2002) Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 96:576–582PubMedCrossRefGoogle Scholar
  28. 28.
    Albanese J, Leone M, Delmas A, Martin C (2005) Terlipressin or norepinephrine in hyperdynamic septic shock: a prospective, randomized study. Crit Care Med 33:1897–1902PubMedCrossRefGoogle Scholar
  29. 29.
    Morelli A, Ertmer C, Lange M, Dunser M, Rehberg S, Van Aken H, Pietropaoli P, Westphal M (2008) Effects of short-term simultaneous infusion of dobutamine and terlipressin in patients with septic shock: the DOBUPRESS study. Br J Anaesth 100:494–503PubMedCrossRefGoogle Scholar
  30. 30.
    Morelli A, Ertmer C, Rehberg S, Lange M, Orecchioni A, Cecchini V, Bachetoni A, D’Alessandro M, Van Aken H, Pietropaoli P, Westphal M (2009) Continuous terlipressin versus vasopressin infusion in septic shock (TERLIVAP): a randomized, controlled pilot study. Crit Care 13:R130PubMedCrossRefGoogle Scholar
  31. 31.
    Yildizdas D, Yapicioglu H, Celik U, Sertdemir Y, Alhan E (2008) Terlipressin as a rescue therapy for catecholamine-resistant septic shock in children. Intensive Care Med 34:511–517PubMedCrossRefGoogle Scholar
  32. 32.
    Ceneviva G, Paschall JA, Maffei F, Carcillo JA (1998) Hemodynamic support in fluid-refractory pediatric septic shock. Pediatrics 102:e19PubMedCrossRefGoogle Scholar
  33. 33.
    Higgins JPT GS (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. (updated March 2011). The Cochrane collaboration, 2011. Available from http:\\www.cochrane-handbook.org. In: Editor (eds.) Book Cochrane handbook for systematic reviews of interventions version 5.1.0. (updated March 2011). The Cochrane collaboration, 2011. Available from http:\\www.cochrane-handbook.org
  34. 34.
    Holmes CL, Patel BM, Russell JA, Walley KR (2001) Physiology of vasopressin relevant to management of septic shock. Chest 120:989–1002PubMedCrossRefGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Angelo Polito
    • 1
  • Emilio Parisini
    • 2
  • Zaccaria Ricci
    • 1
  • Sergio Picardo
    • 1
  • Djillali Annane
    • 3
  1. 1.Department of CardiologyBambino Gesù Children’s HospitalRomeItaly
  2. 2.Center for Nano Science and Technology@POLIMI, Istituto Italiano di TecnologiaMilanItaly
  3. 3.Critical Care DepartmentHôpital Raymond Poincaré (Assistance Publique-Hôpitaux de Paris), University of VersaillesGarchesFrance

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