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

Abstract

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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