Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Dec 18, 2020; 9(5): 88-98
Published online Dec 18, 2020. doi: 10.5492/wjccm.v9.i5.88
Vasopressin in vasoplegic shock: A systematic review
Andrew J Webb, Mohamed O Seisa, Tarek Nayfeh, Patrick M Wieruszewski, Scott D Nei, Nathan J Smischney
Andrew J Webb, Department of Pharmacy, Oregon Health and Science University, Portland, OR 97239, United States
Mohamed O Seisa, Tarek Nayfeh, Robert D and Patricia E Kern Center For The Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, United States
Patrick M Wieruszewski, Scott D Nei, Department of Pharmacy, Mayo Clinic, Rochester, MN 55905, United States
Nathan J Smischney, Department of Anesthesia, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: All authors equally contributed to data collection, interpretation, and manuscript writing.
Conflict-of-interest statement: The authors have nothing to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nathan J Smischney, MD, MSc, Assistant Professor, Department of Anesthesia, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. smischney.nathan@mayo.edu
Received: August 1, 2020
Peer-review started: August 1, 2020
First decision: September 17, 2020
Revised: October 10, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: December 18, 2020
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 vs non-vasopressin alternatives on the clinical and patient-centered outcomes of vasoplegic shock in adult intensive care unit (ICU) patients.

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.

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

Core Tip: In this systematic review of vasopressin vs alternative vasoactive agents for the treatment of vasoplegic shock, vasopressin was not found to be superior to alternative pressor therapy for any of the included outcomes. However, results are limited by mixed methodologies, small overall sample size, and heterogenous populations.