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Continuous IV Infusion is the Choice Treatment Route for Arginine-vasopressin Receptor Blocker Conivaptan in Mice to Study Stroke-evoked Brain Edema
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Vasopressors for hypotensive shock.

Gunnar Gamper1, Christof Havel, Jasmin Arrich

  • 1Department of Cardiology, Universitätsklinikum Sankt Pölten, Sankt Pölten, Austria.

The Cochrane Database of Systematic Reviews
|February 16, 2016
PubMed
Summary
This summary is machine-generated.

This review found no significant differences in total mortality between various vasopressor regimens for shock. However, dopamine increased arrhythmia risk compared to norepinephrine, suggesting individualized vasopressor selection is key.

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Area of Science:

  • Critical Care Medicine
  • Pharmacology
  • Clinical Trials

Background:

  • Hypotensive shock resuscitation typically involves intravenous fluids and vasopressors.
  • The impact of vasopressors on patient-relevant outcomes beyond immediate hemodynamics remains debated.
  • This systematic review was initially published in 2004 and updated in 2011 and 2016.

Purpose of the Study:

  • To compare vasopressor regimens for their effect on mortality in critically ill patients with shock.
  • To investigate the impact on other patient-relevant outcomes and assess bias influence.
  • To evaluate different vasopressor combinations versus single-agent use.

Main Methods:

  • Systematic search of multiple databases (CENTRAL, MEDLINE, EMBASE, etc.) up to June 2015.
  • Inclusion of randomized controlled trials (RCTs) comparing vasopressor regimens for hypotensive shock.
  • Independent data abstraction by two reviewers, with third-author resolution for disagreements; random-effects model used for analysis.

Main Results:

  • 28 RCTs (3497 participants) were analyzed, reporting 1773 mortality outcomes.
  • No significant differences in total mortality were found between any vasopressor comparisons.
  • Dopamine use was associated with a higher incidence of arrhythmias compared to norepinephrine (high-quality evidence).

Conclusions:

  • No substantial differences in total mortality were observed between various vasopressors.
  • Dopamine may increase arrhythmia risk and potentially mortality compared to norepinephrine.
  • Current treatment goals for vasopressor use may have limited clinical value; individualized selection based on hypoperfusion is suggested.