Vasopressin in vasoplegic shock:A systematic review  

作　　者：Andrew J Webb Mohamed O Seisa Tarek Nayfeh Patrick M Wieruszewski Scott D Nei Nathan J Smischney 

机构地区：[1]Department of Pharmacy,Oregon Health and Science University,Portland,OR 97239,United States [2]Robert D and Patricia E Kern Center For The Science of Health Care Delivery,Mayo Clinic,Rochester,MN 55905,United States [3]Department of Pharmacy,Mayo Clinic,Rochester,MN 55905,United States [4]Department of Anesthesia,Mayo Clinic,Rochester,MN 55905,United States

出　　处：《World Journal of Critical Care Medicine》2020年第5期88-98,共11页世界重症医学杂志

摘　　要：BACKGROUNDVasoplegic shock is a challenging complication of cardiac surgery and is oftenresistant to conventional therapies for shock. Norepinephrine and epinephrine arestandards of care for vasoplegic shock, but vasopressin has increasingly been usedas a primary pressor in vasoplegic shock because of its unique pharmacology andlack of inotropic activity. It remains unclear whether vasopressin has distinctbenefits over standard of care for patients with vasoplegic shock.AIMTo summarize the available literature evaluating vasopressin vs non-vasopressinalternatives on the clinical and patient-centered outcomes of vasoplegic shock inadult intensive care unit (ICU) patients.METHODSThis was a systematic review of vasopressin in adults (≥ 18 years) with vasoplegicshock after cardiac surgery. Randomized controlled trials, prospective cohorts,and retrospective cohorts comparing vasopressin to norepinephrine, epinephrine,methylene blue, hydroxocobalamin, or other pressors were included. The primaryoutcomes of interest were 30-d mortality, atrial/ventricular arrhythmias, stroke,ICU length of stay, duration of vasopressor therapy, incidence of acute kidneyinjury stage II-III, and mechanical ventilation for greater than 48 h.RESULTSA total of 1161 studies were screened for inclusion with 3 meeting inclusioncriteria with a total of 708 patients. Two studies were randomized controlled trials and one was a retrospective cohort study. Primary outcomes of 30-d mortality,stroke, ventricular arrhythmias, and duration of mechanical ventilation weresimilar between groups. Conflicting results were observed for acute kidney injurystage II-III, atrial arrhythmias, duration of vasopressors, and ICU length of staywith higher certainty of evidence in favor of vasopressin serving a protective rolefor these outcomes.CONCLUSIONVasopressin was not found to be superior to alternative pressor therapy for any ofthe included outcomes. Results are limited by mixed methodologies, small overallsample size, and heterogenous populations.

关 键 词：VASOPRESSINS Shock Vasoactive agents Treatment outcome Vasoplegia Arginine vasopressin 

分 类 号：R459.7[医药卫生—急诊医学]