Canadian Critical Care Society clinical practice guideline: The use of vasopressin and vasopressin analogues in critically ill adults with distributive shock
| Autor: | Kevin J. Um, Edita Hajdini, Francois Lamontagne, Rohit K. Singal, Margaret S. Herridge, Chris Farley, Kirsten M. Fiest, Salmaan Kanji, Bram Rochwerg, Waleed Alhazzani, Jennifer L Y Tsang, Christine Wynne, Carmen Hrymak, Bojan Paunovic, Kimia Honarmand, Emilie P. Belley-Côté, Morten Hylander Møller, François Lauzier, Shannon M. Fernando, Sangeeta Mehta, Donna Grey |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Canada medicine.medical_specialty Vasopressin Critical Care Vasopressins Critical Illness MEDLINE law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Anesthesiology medicine Humans 030212 general & internal medicine Intensive care medicine business.industry Shock 030208 emergency & critical care medicine General Medicine Guideline medicine.disease Confidence interval Anesthesiology and Pain Medicine Distributive shock Relative risk Anesthesia business |
| Zdroj: | Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 67:369-376 |
| ISSN: | 1496-8975 0832-610X |
| DOI: | 10.1007/s12630-019-01546-x |
| Popis: | Hemodynamic management of adults with distributive shock often includes the use of catecholamine-based vasoconstricting medications. It is unclear whether adding vasopressin or vasopressin analogues to catecholamine therapy is beneficial in the management of patients with distributive shock. The purpose of this guideline was to develop an evidence-based recommendation regarding the addition of vasopressin to catecholamine vasopressors in the management of adults with distributive shock. We summarized the evidence informing this recommendation by updating a recently published meta-analysis. Then, a multidisciplinary panel from the Canadian Critical Care Society developed the recommendation using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The updated systematic review identified 25 randomized controlled trials including a total of 3,737 patients with distributive shock. Compared with catecholamine therapy alone, the addition of vasopressin or its analogues was associated with a reduced risk of mortality (relative risk [RR], 0.91; 95% confidence interval [CI], 0.85 to 0.99; low certainty), reduced risk of atrial fibrillation (RR, 0.77; 95% CI, 0.67 to 0.88; high certainty), and increased risk of digital ischemia (RR, 2.56; 95% CI, 1.24 to 5.25; moderate certainty). After considering certainty in the evidence, values and preferences, cost, and other factors, the expert guideline panel suggests using vasopressin or vasopressin analogues in addition to catecholamines over catecholamine vasopressors alone for the management of distributive shock (conditional recommendation, low certainty evidence). |
| Databáze: | OpenAIRE |
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