Timing of Vasopressin Addition to Norepinephrine and Efficacy Outcomes in Patients With Septic Shock

Brask, Allison L.; Shemanski, Shelby; Barnes, Tyler E.; Holmes, Ashley K.

doi:10.1177/10600280221118903

Cited by 3 publications

(1 citation statement)

References 22 publications

(19 reference statements)

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“…There were 10,842 retrieved articles, and 23 articles published between 2008 and 2023 that met the inclusion criteria were included (Fig. 1), involving 2 RCTs and 21 cohort studies with a total of 25,721 septic shock patients (6)(7)(8)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). The study characteristics are summarized in Table 1.…”

Section: Search Resultsmentioning

confidence: 99%

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: Search Resultsmentioning

confidence: 99%

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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Optimizing Vasopressin Use and Initiation Timing in Septic Shock

Sacha

Bauer

2023

CHEST

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Clinical efficacy and safety of vasopressin and its analogues in patients with septic shock: a meta-analysis and trial sequential analysis

dong,

Li,

Jiang

et al. 2024

Preprint

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Background The guidelines recommend norepinephrine as the first-line drug for the treatment of septic shock, with vasopressin as a complementary drug. However, there is currently no conclusive evidence on the difference in clinical outcomes between vasopressin and norepinephrine in the treatment of septic shock. The aim of this updated meta-analysis was to evaluate the safety and efficacy of vasopressors compared to catecholamines in managing septic shock patients. Methods We conducted a study that included literatures published from inception to August 31, 2023, using databases such as MEDLINE (via PubMed), Embase, Web of Science (WOS), and CENTRAL. The study only included articles published in English. Randomized controlled trials (RCTs) that compared vasopressin with catecholamine alone in septic shock patients were included in this meta-analysis. Pooled effects of relative risk (RR) or mean difference (MD) and their corresponding 95% confidence interval (CI) were calculated using a random/fixed-effects model based on the heterogeneity. Results: Twenty-four studies, involving a total of 4080 participants, were included in the analysis. The combined analysis of vasopressin did not show a significant reduction in 28-day/90-day/ICU/hospital mortality or total mortality (RR, 0.95; 95% CI 0.88–1.02; P = 0.14). This finding was further confirmed by sensitive analyses. However, when considering underlying disease in a subgroup analysis, vasopressin demonstrated benefits in reducing mortality (RR, 0.86; 95% CI 0.75–0.99; P = 0.04), while terlipressin performed even better (RR, 0.74; 95% CI 0.62–0.89; P < 0.01). The pooled analysis also indicated a significant reduction in mechanical ventilation duration with vasopressin (MD -0.60, 95% CI -1.10~-0.11, P = 0.02) and lower norepinephrine doses (MD -10.81, 95% CI -16.78~-4.83, P < 0.01). Additionally, the data suggested a 29% decreased risk of renal replacement therapy in the vasopressin group, but a 2.85 times higher risk of digital ischemia. However, there were no significant differences observed in ICU-LOS, SOFA score change, lactate change, and other adverse events. Conclusions: According to research, vasopressin has shown potential in reducing mortality rates among septic shock patients with underlying diseases. Therefore, when treating patients with septic shock, healthcare professionals should carefully consider the benefits and drawbacks of using vasopressin and make a personalized treatment approach.

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Timing of Vasopressin Addition to Norepinephrine and Efficacy Outcomes in Patients With Septic Shock

Cited by 3 publications

References 22 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

Optimizing Vasopressin Use and Initiation Timing in Septic Shock

Clinical efficacy and safety of vasopressin and its analogues in patients with septic shock: a meta-analysis and trial sequential analysis

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