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Evidence summaries

Vasopressors for Shock

There is no evidence to support a particular vasopressor to be superior to other agents in states of shock. Level of evidence: "D"

A Cochrane review [Abstract] 1 included eight RCTs with a total of 192 subjects in different comparison settings. The studies used mainly surrogate measures such as blood pressure and cardiac index as outcomes. Two studies compared norepinephrine plus dobutamine with epinephrine alone in patients with septic shock (52 patients, relative risk of death 0.98, 95% confidence interval 0.57 to 1.67). Three studies compared norepinephrine with dopamine in patients with septic shock (62 patients, relative risk 0.88, 0.57 to 1.36). Two studies compared vasopressin with placebo in patients with septic shock (58 patients, relative risk 1.04, 0.06 to 19.33). One study compared terlipressin with norepinephrine in patients with refractory hypotension after general anaesthesia but there were no deaths (20 patients). Available evidence does not reveal whether a particular vasopressor is superior to other agents in states of shock and thus it is not suited to inform clinical practice.

Comment: The quality of evidence is downgraded by limitations in study quality (inadequate follow up), by imprecise results (limited study size for each comparison) and by indirectness (trials almost exclusively conducted in university hospitals, and few looked at patient-oriented outcomes).

    References

    • Müllner M, Urbanek B, Havel C, Losert H, Waechter F, Gamper G. Vasopressors for shock. Cochrane Database Syst Rev 2004;(3):CD003709. [PubMed]

Primary/Secondary Keywords