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Evidence summaries

Naloxone for Shock

Naloxone may be beneficial in septic shock, but the number of patients studied is small and there is a possibility of publication bias. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 6 studies with a total of 126 subjects with septic, cardiogenic, hemorrhagic, or spinal shock. Naloxone therapy was associated with statistically significant hemodynamic improvement (OR 0.24, 95% CI 0.09 to 0.68). The mean arterial pressure was significantly higher in the naloxone groups than in the placebo groups (WMD +9.33 mm Hg, 95% CI 7.07 to 11.59; 3 studies, n=66). There was no statistically significant difference in the death rate, although the trend favored naloxone (OR 0.59, 95% CI 0.21 was 1.67; significant heterogeneity I2 =67%; 3 studies, n=59).

Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals) and by potential reporting bias (only few small trials reported).

    References

    • Boeuf B, Poirier V, Gauvin F, Guerguerian AM, Roy C, Farrell CA, Lacroix J. Naloxone for shock. Cochrane Database Syst Rev 2003;(4):CD004443 [Review content assessed as up-to-date: 4 December 2008][PubMed]

Primary/Secondary Keywords