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 journalArticle (Academic Journal)

17 Citations (Scopus)
291 Downloads (Pure)

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 patient with at least one 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 =0.42, 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 pages7
JournalJournal of Critical Care
Volume37
Early online date13 Aug 2016
DOIs
Publication statusPublished - Feb 2017

Structured keywords

  • Centre for Surgical Research

Keywords

  • Sepsis
  • vasopressors
  • inotropes
  • intensive care
  • microcirculation
  • mortality

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