Is the addition of vasopressin to norepinephrine beneficial for the treatment of septic shock?

摘要

A total of 9 articles totaling 998 patients were included in the systematic review; however, only 4 of these studies specifically evaluated vasopressin in septic shock. In the sepsis subgroup analysis, 2 of the 4 trials were blinded and only 1 followed an intention-to-treat analysis. A sensitivity analysis based on the high-quality studies revealed no difference in mortality.CommentarySeptic shock is a common illness presenting to the emergency department. After adequate volume resuscitation, vasoactive medications are typically used to treat persistent hypotension. Catecholamines such as dopamine and norepinephrine are often the preferred agent, but they can have adverse effects, including arrhythmias.1 This review examined whether low-dose vasopressin or its analog terlipressin added to norepinephrine reduces mortality in patients with septic shock. The rationale for vasopressin use is that circulating vasopressin levels are low in patients with septic shock and the administration of exogenous vasopressin has been shown to increase blood pressure and decrease vasopressor requirements in these patients.