The effect of vasoactive drugs on mortality in patients with severe sepsis and septic shock. A network meta-analysis of randomized trials

Alessandro Belletti, Umberto Benedetto, Giuseppe Biondi-Zoccai, Carlo Leggieri, Paolo Silvani, Gianni D Angelini, Alberto Zangrillo, Giovanni Landoni

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: Inotropes and vasopressors are cornerstone of therapy in septic shock, but search for the best agent is ongoing. We aimed to determine which vasoactive drug is associated with the best survival.

MATERIALS AND METHODS: PubMed, BioMedCentral, Embase, and the Cochrane Central Register were searched. Randomized trials performed in septic patients with at least 1 group allocated to an inotrope/vasopressor were included. Network meta-analysis with a frequentist approach was performed.

RESULTS: The 33 included studies randomized 3470 patients to 16 different comparators. As compared with placebo, levosimendan (odds ratio [OR], 0.17, 95%; confidence interval [CI], 0.05-0.60), dobutamine (OR, 0.30; 95% CI, 0.09-0.99), epinephrine (OR, 0.35; 95% CI, 0.13-0.96), vasopressin (OR, 0.37; 95% CI, 0.16-0.89), and norepinephrine plus dobutamine (OR, 0.4; 95% CI, 0.11-0.96) were significantly associated with survival. Norepinephrine improved survival compared with dopamine (OR, 0.81; 95% CI, 0.66-1.00). Rank analysis showed that levosimendan had the highest probability of being the best treatment.

CONCLUSIONS: Among several regimens for pharmacological cardiovascular support in septic patients, regimens based on inodilators have the highest probability of improve survival.

Original languageEnglish
Pages (from-to)91-98
Number of pages8
JournalJournal of Critical Care
Volume37
DOIs
Publication statusPublished - Feb 2017

Keywords

  • Arginine Vasopressin
  • Cardiotonic Agents
  • Dobutamine
  • Dopamine
  • Epinephrine
  • Humans
  • Hydrazones
  • Network Meta-Analysis
  • Norepinephrine
  • Odds Ratio
  • Pyridazines
  • Randomized Controlled Trials as Topic
  • Sepsis
  • Shock, Septic
  • Treatment Outcome
  • Vasoconstrictor Agents
  • Vasopressins
  • Journal Article
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

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