%0 Journal Article
%T Vasopressin and terlipressin in adult vasodilatory shock: a systematic review and meta-analysis of nine randomized controlled trials
%A Ary Serpa Neto
%A Ant£¿nio P Nassar
%A S¨¦rgio O Cardoso
%A Jos¨¦ A Manetta
%A Victor GM Pereira
%A Daniel C Esp¨®sito
%A Maria CT Damasceno
%A James A Russell
%J Critical Care
%D 2012
%I BioMed Central
%R 10.1186/cc11469
%X A systematic review and meta-analysis of publications between 1966 and 2011 was performed. The Medline and CENTRAL databases were searched for studies on vasopressin and terlipressin in critically ill patients. The meta-analysis was limited to randomized controlled trials evaluating the use of vasopressin and/or terlipressin compared with catecholamine in adult patients with vasodilatory shock. The assessed outcomes were: overall survival, changes in the hemodynamic and biochemical variables, a decrease of catecholamine requirements, and adverse events.Nine trials covering 998 participants were included. A meta-analysis using a fixed-effect model showed a reduction in norepinephrine requirement among patients receiving terlipressin or vasopressin infusion compared with control (standardized mean difference, -1.58 (95% confidence interval, -1.73 to -1.44); P < 0.0001). Overall, vasopressin and terlipressin, as compared with norepinephrine, reduced mortality (relative risk (RR), 0.87 (0.77 to 0.99); P = 0.04). Vasopressin compared with norepinephrine decreased mortality in adult patients (RR, 0.87 (0.76 to 1.00); P = 0.05) and in patients with septic shock (42.5% vs. 49.2%, respectively; RR, 0.87 (0.75 to 1.00); P = 0.05; number needed to treat, 1 to 15). There was no difference in adverse events between the vasopressin and control groups (RR, 0.98 (0.65 to 1.47); P = 0.92).Vasopressin use in vasodilatory shock is safe, associated with reduced mortality, and facilitates weaning of catecholamines. In patients with septic shock, use of vasopressin compared with norepinephrine may also decrease mortality.The mortality rate of patients with shock remains high [1]. Vasodilatory shock is characterized by low arterial blood pressure due to a significantly decreased systemic vascular resistance. The most frequent causes of this type of shock are sepsis and post-cardiovascular surgery requiring cardiopulmonary bypass. However, massive vasodilatation can result from shock of an
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