The Effects and Safety of Vasopressin Receptor Agonists in Patients With Septic Shock

A Meta-analysis and Trial Sequential Analysis

Libing Jiang; Yi Sheng; Xia Feng; Jing Wu


Crit Care. 2019;23(91) 

In This Article


Septic shock is the leading cause of death in intensive care units. It is reported that the mortality rate of these patients can be as high as 30–60%.[1–3] Maintaining effective blood pressure is important for these patients.[4] Vasopressors are often used to reach a target mean arterial pressure (MAP), after adequate fluid resuscitation. Catecholamines, such as norepinephrine (NE), are still the first-line drugs. However, high dose of catecholamines may be associated with a higher risk of complications, including myocardial ischemia, decreased cardiac output, arrhythmias, increased tissue oxygen consumption, and pulmonary hypertension.[4,5]

Relative vasopressin deficiency often occurs in septic shock patients.[6,7] Some pre-clinical studies showed exogenous administration of vasopressin could increase the vascular tone and improve blood pressure.[8] Several clinical studies also reported early concomitant vasopressin, and norepinephrine therapy could reduce the dose of NE, shorten the time of achieving target mean arterial pressure, and reduce catecholamine-related complications.[9,10] Therefore, the newest Surviving Sepsis guideline suggests vasopressin could be used to raise blood pressure to target mean arterial pressure or decrease norepinephrine dosage with weak recommendations.[11] However, no consensus has been made regarding the effects of vasopressin receptor agonists on patient-centered outcomes, especially mortality. The aim of this study is to explore the effects and safety of vasopressin receptor agonists in patients with septic shock.