TY - JOUR
T1 - The effect of vasoactive drugs on mortality in patients with severe sepsis and septic shock. A network meta-analysis of randomized trials
AU - Belletti, A
AU - Benedetto, U
AU - Biondi-Zoccai, G
AU - Leggieri, C
AU - Silvani, P
AU - Angelini, GD
AU - Zangrillo, A
AU - Landoni, G
PY - 2017
Y1 - 2017
N2 - 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 comparedwith 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. © 2016 Elsevier Inc. All rights reserved
AB - 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 comparedwith 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. © 2016 Elsevier Inc. All rights reserved
U2 - 10.1016/j.jcrc.2016.08.010
DO - 10.1016/j.jcrc.2016.08.010
M3 - Article
VL - 37
SP - 91
EP - 98
JO - Journal of Critical Care
JF - Journal of Critical Care
SN - 0883-9441
IS - 10
ER -