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World J Crit Care Med. Sep 9, 2023; 12(4): 204-216
Published online Sep 9, 2023. doi: 10.5492/wjccm.v12.i4.204
Should we initiate vasopressors earlier in patients with septic shock: A mini systemic review
Hang-Xiang Zhou, Chun-Fu Yang, He-Yan Wang, Yin Teng, Hang-Yong He
Hang-Xiang Zhou, Department of Critical Care Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
Hang-Xiang Zhou, Chun-Fu Yang, He-Yan Wang, Department of Critical Care Medicine, The Sixth Hospital of Guiyang, Guiyang 550002, Guizhou Province, China
Chun-Fu Yang, Department of Respiratory Medicine, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 550002, Guizhou Province, China
He-Yan Wang, School of Basic Medicine, Guizhou University of Traditional Chinese Medicine, Guiyang 550002, Guizhou Province, China
Yin Teng, Department of Thoracic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
Hang-Yong He, Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing 100020, China
Hang-Yong He, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Beijing 100020, China
Hang-Yong He, Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Chao-Yang Hospital, Beijing 100020, China
Author contributions: Zhou HX, Yang CF, and Wang HY drafted the manuscript; Teng Y and He HY designed and reviewed the manuscript, and revised it for critical intellectual content; all authors have read and approved the final version.
Conflict-of-interest statement: All authors declare that they have no competing interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hang-Yong He, MD, Chief Physician, Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, No. 8 GongrenTiyuchangSouth Road, Chaoyang District, Beijing 100020, China. yonghang2004@sina.com
Received: March 20, 2023
Peer-review started: March 20, 2023
First decision: June 14, 2023
Revised: June 28, 2023
Accepted: July 17, 2023
Article in press: July 17, 2023
Published online: September 9, 2023
Abstract

Septic shock treatment remains a major challenge for intensive care units, despite the recent prominent advances in both management and outcomes. Vasopressors serve as a cornerstone of septic shock therapy, but there is still controversy over the timing of administration. Specifically, it remains unclear whether vasopressors should be used early in the course of treatment. Here, we provide a systematic review of the literature on the timing of vasopressor administration. Research was systematically identified through PubMed, Embase and Cochrane searching according to PRISMA guidelines. Fourteen studies met the eligibility criteria and were included in the review. The pathophysiological basis for early vasopressor use was classified, with the exploration on indications for the early administration of mono-vasopressors or their combination with vasopressin or angiotensinII. We found that mortality was 28.1%-47.7% in the early vasopressors group, and 33.6%-54.5% in the control group. We also investigated the issue of vasopressor responsiveness. Furthermore, we acknowledged the subsequent challenge of administration of high-dose norepinephrine via peripheral veins with early vasopressor use. Based on the literature review, we propose a possible protocol for the early initiation of vasopressors in septic shock resuscitation.

Keywords: Septic shock, Resuscitation, Vasopressor, Norepinephrine, Vasopressin, Timing

Core tip: It remains unclear whether vasopressors should be used early in the course of treatment of septic shock. Here, we provide a systematic review of the literature on the timing of vasopressor administration. The pathophysiological basis for early vasopressors use was classified, with the exploration on indications for the early administration of mono-vasopressors or their combination with vasopressin or angiotensinII. We also investigated the issue of vasopressor responsiveness and the subsequent challenge of administrating high-dose norepinephrine via the peripheral vein with early vasopressor use. Based on the literature review, we propose a possible protocol for the early initiation of vasopressors in septic shock resuscitation.