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

Disclosures

Crit Care. 2019;23(91) 

In This Article

Background

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.

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