The effect of early vasopressin use on patients with septic shock: A systematic review and meta-analysis

Huang, Haijun; Wu, Chenxia; Shen, Qinkang; Xu, Hua; Fang, Yixin; Mao, Wei

doi:10.1016/j.ajem.2021.05.007

Cited by 19 publications

(17 citation statements)

References 21 publications

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“…We also observed an association between early use of vasopressin and short-term mortality and length of in-hospital stay, which were contrasted with a previous meta-analysis (48) for the inclusion of newly published studies as well as the exclusion of studies in which the patients in the late group did not receive vasopressin. The rationale may lie in the catecholamine sparing effect, because our result show that its early initiation was associated with shorter vasopressor use duration, which may reduce the immune paralysis effect of norepinephrine in the late phase of sepsis progression.…”

Section: Discussioncontrasting

confidence: 71%

Initiation Timing of Vasopressor in Patients With Septic Shock: A Systematic Review and Meta-Analysis

Ye,

Wang

et al. 2023

Shock

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Background Vasopressor plays a crucial role in septic shock. However, the time for vasopressor initiation remains controversial. We conducted a systematic review and meta-analysis to explore its initiation timing for septic shock patients. Methods PubMed, Cochrane Library, Embase, and Web of Sciences were searched from inception to July 12nd, 2023 for relevant studies. Primary outcome was short-term mortality. Meta-analysis was performed using Stata 15.0. Results Twenty-three studies were assessed, including 2 RCTs and 21 cohort studies. The early group resulted in lower short-term mortality than the late group [OR (95%CI) =0.775 (0.673, 0.893), p = 0.000, I2 = 67.8%]. The significance existed in the norepinephrine and vasopressin in sub-group analysis. No significant difference was considered in the association between each hour’s vasopressor delay and mortality [OR (95%CI) =1.02 (0.99, 1.051), p = 0.195, I2 = 57.5%]. The early group had an earlier achievement of target MAP (p < 0.001), shorter vasopressor use duration (p < 0.001), lower serum lactate level at 24 h (p = 0.003), lower incidence of kidney injury (p = 0.001) and RRT use (p = 0.022), longer ventilation-free days to 28 days (p < 0.001). Conclusions Early initiation of vasopressor (1-6 h within septic shock onset) would be more beneficial to septic shock patients. The conclusion needs to be further validated by more well-designed RCTs.

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Section: Discussioncontrasting

confidence: 71%

Initiation Timing of Vasopressor in Patients With Septic Shock: A Systematic Review and Meta-Analysis

Ye,

Wang

et al. 2023

Shock

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“…The results were very uncertain and discussable. A meta-analysis including the results obtained on 788 patients treated with early administration of vasopressin (6 h septic shock) did not show any advantage with the comparator group, treated with the usual protocol [ 18 ]. A further study was addressed to identify the procedures used in intensive care, when patients with AKI where treated [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Norepinephrine May Exacerbate Septic Acute Kidney Injury: A Narrative Review

Al-Husinat

Alsabbah

Hmaid

et al. 2023

JCM

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Sepsis, the most serious complication of infection, occurs when a cascade of potentially life-threatening inflammatory responses is triggered. Potentially life-threatening septic shock is a complication of sepsis that occurs when hemodynamic instability occurs. Septic shock may cause organ failure, most commonly involving the kidneys. The pathophysiology and hemodynamic mechanisms of acute kidney injury in the case of sepsis or septic shock remain to be elucidated, but previous studies have suggested multiple possible mechanisms or the interplay of multiple mechanisms. Norepinephrine is used as the first-line vasopressor in the management of septic shock. Studies have reported different hemodynamic effects of norepinephrine on renal circulation, with some suggesting that it could possibly exacerbate acute kidney injury caused by septic shock. This narrative review briefly covers the updates on sepsis and septic shock regarding definitions, statistics, diagnosis, and management, with an explanation of the putative pathophysiological mechanisms and hemodynamic changes, as well as updated evidence. Sepsis-associated acute kidney injury remains a major burden on the healthcare system. This review aims to improve the real-world clinical understanding of the possible adverse outcomes of norepinephrine use in sepsis-associated acute kidney injury.

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“…Also regarding the recommendation to start VP, Huang et al (2021), in a systematic review, demonstrated that the infusion of vasopressin within 6 hours of the onset of septic shock was not associated with a reduction in mortality and length of stay, but seems to reduce the use of renal replacement therapy (Huang et al 2021). In addition, a prospective open-label trial by Hammond et al (2018) found that the VP and NA group as first choice reached the MAP goal (65 mmHg) faster than the group that used only NA (Hammond et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of vasopressin use in the management of refractory shock in patients admitted to the intensive care unit

Macedo

Miyoshi

Baglie

et al. 2022

RSD

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Refractory shock is characterized by hemodynamic instability unresponsive to norepinephrine with a high mortality rate. As there are still doubts regarding the pharmacological benefit of the vasopressin addition, this retrospective study aimed to assess the profile of vasopressin use in the intensive care unit of a university hospital in Paraná, Brazil. The information collected was obtained through the analysis of electronic medical records. 73 patients with refractory shock, mainly of septic etiology (61.6%), were included. The dose (μg/Kg/minute) and duration of norepinephrine, upon finding refractoriness, was 35.6% infusion < 1, 34, 3% of 1-1.9, 30.1% > 2 and mean time of 1.5 days. High mortality (80.8%) was observed, with a mean hospital stay of 8.2 days. Median survival after vasopressin infusion was 4.5 days until the unfavorable outcome. Still, 80.5% of patients used other adjuvant therapy, 71.2% being corticotherapy and 9.6% dobutamine. Due to the great variability, it was not possible to define a pattern of use. There were limitations in the analysis due to the lack of clinical and prognostic information. However, the need for deepening scientific discussions and continuous updating of protocols that guide management is highlighted.

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The effect of early vasopressin use on patients with septic shock: A systematic review and meta-analysis

Cited by 19 publications

References 21 publications

Initiation Timing of Vasopressor in Patients With Septic Shock: A Systematic Review and Meta-Analysis

Initiation Timing of Vasopressor in Patients With Septic Shock: A Systematic Review and Meta-Analysis

Norepinephrine May Exacerbate Septic Acute Kidney Injury: A Narrative Review

Evaluation of vasopressin use in the management of refractory shock in patients admitted to the intensive care unit

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