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Cited by 225Sepsis Diagnosis and TreatmentHemodynamic Monitoring and TherapyTrauma, Hemostasis, Coagulopathy, Resuscitation

The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index.

Association of Vasopressin Plus Catecholamine Vasopressors vs Catecholamines Alone With Atrial Fibrillation in Patients With Distributive Shock: A Systematic Review and Meta-analysis

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McIntyre, William F., Um, Kevin J., Alhazzani, Waleed, Lengyel, Alexandra P., Hajjar, Ludhmila, Gordon, Anthony C., Lamontagne, François, Healey, Jeff S., Whitlock, Richard P., Belley-Côté, Emilie P.·2018·JAMA
DOI 10.1001/jama.2018.4528PMC PMC6583502
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Abstract

Importance: Vasopressin is an alternative to catecholamine vasopressors for patients with distributive shock-a condition due to excessive vasodilation, most frequently from severe infection. Blood pressure support with a noncatecholamine vasopressor may reduce stimulation of adrenergic receptors and decrease myocardial oxygen demand. Atrial fibrillation is common with catecholamines and is associated with adverse events, including mortality and increased length of stay (LOS). Objectives: To determine whether treatment with vasopressin + catecholamine vasopressors compared with catecholamine vasopressors alone was associated with reductions in the risk of adverse events. Data Sources: MEDLINE, EMBASE, and CENTRAL were searched from inception to February 2018. Experts were asked and meta-registries searched to identify ongoing trials. Study Selection: Pairs of reviewers identified randomized clinical trials comparing vasopressin in combination with catecholamine vasopressors to catecholamines alone for patients with distributive shock. Data Extraction and Synthesis: Two reviewers abstracted data independently. A random-effects model was used to combine data. Main Outcomes and Measures: The primary outcome was atrial fibrillation. Other outcomes included mortality, requirement for renal replacement therapy (RRT), myocardial injury, ventricular arrhythmia, stroke, and LOS in the intensive care unit and hospital. Measures of association are reported as risk ratios (RRs) for clinical outcomes and mean differences for LOS. Results: Twenty-three randomized clinical trials were identified (3088 patients; mean age, 61.1 years [14.2]; women, 45.3%). High-quality evidence supported a lower risk of atrial fibrillation associated with vasopressin treatment (RR, 0.77 [95% CI, 0.67 to 0.88]; risk difference [RD], -0.06 [95% CI, -0.13 to 0.01]). For mortality, the overall RR estimate was 0.89 (95% CI, 0.82 to 0.97; RD, -0.04 [95% CI, -0.07 to 0.00]); however, when limited to trials at low risk of bias, the RR estimate was 0.96 (95% CI, 0.84 to 1.11). The overall RR estimate for RRT was 0.74 (95% CI, 0.51 to 1.08; RD, -0.07 [95% CI, -0.12 to -0.01]). However, in an analysis limited to trials at low risk of bias, RR was 0.70 (95% CI, 0.53 to 0.92, P for interaction = .77). There were no significant differences in the pooled risks for other outcomes. Conclusions and Relevance: In this systematic review and meta-analysis, the addition of vasopressin to catecholamine vasopressors compared with catecholamines alone was associated with a lower risk of atrial fibrillation. Findings for secondary outcomes varied.

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Authors
McIntyre, W. F., Um, K. J., Alhazzani, W., Lengyel, A. P., Hajjar, L., Gordon, A. C., Lamontagne, F., Healey, J. S., Whitlock, R. P., & Belley-Côté, E. P.
Affiliations
  • McMaster University (CA)
  • Universidade de São Paulo (BR)
  • Charing Cross Hospital (GB)
  • Université de Sherbrooke (CA)
  • McMaster University, Hamilton, Ontario, Canada
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2018-05-08
Volume
319
Issue
18
Pages
1889
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2018.4528
PMC
PMC6583502
OpenAlex
W2802319261
Cited by
225
References
45
Citations by year
2026: 27 · 2025: 28 · 2024: 28 · 2023: 27 · 2022: 29 · 2021: 20 · 2020: 37 · 2019: 20 · 2018: 9
FWCI
16.77
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • JAMA (publishedVersion, other-oa)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Spiral (Imperial College London) (submittedVersion)
Funders
  • National Institute for Health and Care Research (NIHR/CS/009/007, PB-PG-0610-22350)
  • Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
Keywords
vasopressin, distributive shock, septic shock, atrial fibrillation, mortality, renal replacement therapy, myocardial injury, ventricular arrhythmias, stroke, length of hospital stay, intensive care unit, sepsis, vasodilation, myocardial oxygen demand, fluid resuscitation, vasopressor combination
MeSH terms
Atrial Fibrillation, Catecholamines, Drug Therapy, Combination, Female, Humans, Length of Stay, Male, Shock, Vasoconstrictor Agents, Vasopressins, Publication Bias

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