Vasopressor and inotrope treatment for septic shock: An umbrella review of reviews.

Autor: Einav S; Intensive Care Unit of the Shaare Zedek Medical Medical Centre and Hebrew University Faculty of Medicine, Jerusalem, Israel. Electronic address: einav_s@szmc.org.il., Helviz Y; Intensive Care Unit of the Shaare Zedek Medical Medical Centre and Hebrew University Faculty of Medicine, Jerusalem, Israel., Ippolito M; Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy., Cortegiani A; Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy; Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2021 Oct; Vol. 65, pp. 65-71. Date of Electronic Publication: 2021 May 31.
DOI: 10.1016/j.jcrc.2021.05.017
Abstrakt: Purpose: To review the characteristics, findings and quality of systematic reviews (SRs) on the effect of any vasopressor/inotrope on outcomes in adult patients with sepsis compared with either no treatment, another vasopressor or inotrope or fluids.
Materials and Methods: We systematically searched Cochrane Central Register of Controlled Trials, PubMed and Embase (January 1993-March 2021). Descriptive statistics were used.
Results: Among the 28 SRs identified, mortality was the primary outcome in most (26/28) and mortality was usually (23/28) studied using randomised controlled trials (RCTs). Fifteen SRs focused exclusively on patients with sepsis or septic shock. Sepsis and septic shock were always grouped for the analysis. Publication bias was consistently low when studied. The most consistent findings were a survival advantage with norepinephrine versus dopamine, which disappeared in analyses restricted to 28-day mortality, and more arrhythmias with dopamine. However, these analyses were dominated by a single study. Only 2 SRs were judged to be of moderate-high quality. Lack of blinding and attrition bias may have affected the outcomes.
Conclusions: The quality of SRs on the effect of vasopressors/inotropes on the outcomes of adult patients with sepsis can be improved, but high-quality, multicenter, RCTs should be preferred to additional SRs on this topic.
Competing Interests: Declaration of Competing Interest SE is associate editor of Intensive Care Medicine and a Cochrane Editor. AC is an advisory board member of Critical Care and an associate Editorial Board member of BJA. The other authors declare that they have no competing interests.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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