Vasopressin and terlipressin in adult vasodilatory shock: a systematic review and meta-analysis of nine randomized controlled trials.
Crit Care. 2012 Aug 14;16(4):R154
Authors: Serpa Neto A, Nassar Junior AP, Cardoso SO, Manettta JA, Pereira VG, Esposito DC, Damasceno MC, Russell JA
ABSTRACT: INTRODUCTION: Catecholamines are the most used vasopressors in vasodilatory shock. However, the development of adrenergic hyposensitivity and the subsequent loss of catecholamine pressor activity necessitate the search for other options. Our aim was to evaluate the effects of vasopressin and its analogue terlipressin compared with cathecolamine infusion alone in vasodilatory shock. METHODS: Systematic review and meta-analysis of publications between 1966 and 2011. The Medline and CENTRAL databases were searched for studies on vasopressin and terlipressin in critically ill patients. The meta-analysis was limited randomized controlled trials evaluating the use of vasopressin and/or terlipressin compared to cathecolamine in adult patients with vasodilatory shock. The assessed outcomes were: overall survival, changes in the hemodynamic and biochemical variables, a decrease of catecholamine requirements, and adverse events. RESULTS: Nine trials covering 998 participants were included. A meta-analysis using a fixed-effect model showed a reduction in norepinephrine requirement among patients receiving terlipressin or vasopressin infusion compared with control (standardized mean difference, -1.58 [95% CI, -1.73 - -1.44]; p < 0.0001). Overall, vasopressin and terlipressin, as compared with norepinephrine, reduced mortality (relative risk, RR: 0.87 [0.77 - 0.99]; p = 0.04). Vasopressin compared with norepinephrine decreased mortality in adult patients (RR: 0.87 [0.76 - 1.00]; p = 0.05) and in patients with septic shock (42.5 vs. 49.2%, respectively; RR, 0.87 [95% CI, 0.75 - 1.00]; p = 0.05; number needed to treat, 1 to 15). There was no difference between in adverse events between the vasopressin and control groups (RR: 0.98 [0.65 - 1.47]; p = 0.92). CONCLUSIONS: Vasopressin use in vasodilatory shock is safe, associated with reduced mortality, and facilitates weaning of catecholamines. In patients with septic shock vasopressin compared to norepinephrine may decrease mortality also.
PMID: 22889256 [PubMed - as supplied by publisher]