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Webb AJ, Seisa MO, Nayfeh T, et al. Vasopressin in vasoplegic shock: A systematic review. World J Crit Care Med. 2020;9(5):88-98doi: 10.5492/wjccm.v9.i5.88.
Webb, A. J., Seisa, M. O., Nayfeh, T., Wieruszewski, P. M., Nei, S. D., & Smischney, N. J. (2020). Vasopressin in vasoplegic shock: A systematic review. World journal of critical care medicine, 9(5), 88-98. https://doi.org/10.5492/wjccm.v9.i5.88
Webb, Andrew J, et al. "Vasopressin in vasoplegic shock: A systematic review." World journal of critical care medicine vol. 9,5 (2020): 88-98. doi: https://doi.org/10.5492/wjccm.v9.i5.88
Webb AJ, Seisa MO, Nayfeh T, Wieruszewski PM, Nei SD, Smischney NJ. Vasopressin in vasoplegic shock: A systematic review. World J Crit Care Med. 2020 Dec 18;9(5):88-98. doi: 10.5492/wjccm.v9.i5.88. eCollection 2020 Dec 18. PMID: 33384951; PMCID: PMC7754532.
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World J Crit Care Med. 2020 Dec 18;9(5):88-98. doi: 10.5492/wjccm.v9.i5.88. eCollection 2020 Dec 18.

Vasopressin in vasoplegic shock: A systematic review.

World journal of critical care medicine

Andrew J Webb, Mohamed O Seisa, Tarek Nayfeh, Patrick M Wieruszewski, Scott D Nei, Nathan J Smischney

Affiliations

  1. Department of Pharmacy, Oregon Health and Science University, Portland, OR 97239, United States.
  2. Robert D and Patricia E Kern Center For The Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, United States.
  3. Department of Pharmacy, Mayo Clinic, Rochester, MN 55905, United States.
  4. Department of Anesthesia, Mayo Clinic, Rochester, MN 55905, United States. [email protected].

PMID: 33384951 PMCID: PMC7754532 DOI: 10.5492/wjccm.v9.i5.88

Abstract

BACKGROUND: Vasoplegic shock is a challenging complication of cardiac surgery and is often resistant to conventional therapies for shock. Norepinephrine and epinephrine are standards of care for vasoplegic shock, but vasopressin has increasingly been used as a primary pressor in vasoplegic shock because of its unique pharmacology and lack of inotropic activity. It remains unclear whether vasopressin has distinct benefits over standard of care for patients with vasoplegic shock.

AIM: To summarize the available literature evaluating vasopressin

METHODS: This was a systematic review of vasopressin in adults (≥ 18 years) with vasoplegic shock after cardiac surgery. Randomized controlled trials, prospective cohorts, and retrospective cohorts comparing vasopressin to norepinephrine, epinephrine, methylene blue, hydroxocobalamin, or other pressors were included. The primary outcomes of interest were 30-d mortality, atrial/ventricular arrhythmias, stroke, ICU length of stay, duration of vasopressor therapy, incidence of acute kidney injury stage II-III, and mechanical ventilation for greater than 48 h.

RESULTS: A total of 1161 studies were screened for inclusion with 3 meeting inclusion criteria with a total of 708 patients. Two studies were randomized controlled trials and one was a retrospective cohort study. Primary outcomes of 30-d mortality, stroke, ventricular arrhythmias, and duration of mechanical ventilation were similar between groups. Conflicting results were observed for acute kidney injury stage II-III, atrial arrhythmias, duration of vasopressors, and ICU length of stay with higher certainty of evidence in favor of vasopressin serving a protective role for these outcomes.

CONCLUSION: Vasopressin was not found to be superior to alternative pressor therapy for any of the included outcomes. Results are limited by mixed methodologies, small overall sample size, and heterogenous populations.

©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

Keywords: Arginine vasopressin; Shock; Treatment outcome; Vasoactive agents; Vasoplegia; Vasopressins

Conflict of interest statement

Conflict-of-interest statement: The authors have nothing to disclose.

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