Gary Duclos1, Karine Baumstarck2, Martin Dünser3, Laurent Zieleskiewicz4, Marc Leone5. 1. Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, 13015 Marseille, France. Electronic address: Gary.duclos@ap-hm.fr. 2. Clinical Research Department, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France; Aix-Marseille Université, EA 3279, 13005 Marseille, France. Electronic address: Karine.baumstarck@univ-amu.fr. 3. Kepler University Hospital and Johannes Kepler University Linz, Department of Anesthesiology and Intensive Care Medicine, 4020 Linz, Austria. Electronic address: Martin.duenser@kepleruniklinikum.at. 4. Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, 13015 Marseille, France. Electronic address: laurent.zieleskiewicz@ap-hm.fr. 5. Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, 13015 Marseille, France. Electronic address: Marc.leone@ap-hm.fr.
Abstract
BACKGROUND: Although the order of vasopressor initiation in patients with septic shock is established, limited information is available on the order of vasopressor discontinuation. METHODS: We performed a meta-analysis of nine studies involving 1245 patients in whom norepinephrine (n = 787) or vasopressin (n = 458) was withdrawn first to compare the risk of hypotension. RESULTS: The risk of hypotension increased in patients whom vasopressin was withdrawn first (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.3-8.9; p = 0.01). A sensitivity analysis indicated that this effect was observed in four studies with a high risk of bias (OR, 5.4; 95%CI, 1.3-23.5; p = 0.02) and was not observed in five studies with a low risk of bias (OR, 2.4; 95%CI, 0.6-8.4; p = 0.18). CONCLUSION: Our results suggest that the risk of hypotension is higher in patients with septic shock in whom vasopressin is withdrawn before norepinephrine.
BACKGROUND: Although the order of vasopressor initiation in patients with septic shock is established, limited information is available on the order of vasopressor discontinuation. METHODS: We performed a meta-analysis of nine studies involving 1245 patients in whom norepinephrine (n = 787) or vasopressin (n = 458) was withdrawn first to compare the risk of hypotension. RESULTS: The risk of hypotension increased in patients whom vasopressin was withdrawn first (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.3-8.9; p = 0.01). A sensitivity analysis indicated that this effect was observed in four studies with a high risk of bias (OR, 5.4; 95%CI, 1.3-23.5; p = 0.02) and was not observed in five studies with a low risk of bias (OR, 2.4; 95%CI, 0.6-8.4; p = 0.18). CONCLUSION: Our results suggest that the risk of hypotension is higher in patients with septic shock in whom vasopressin is withdrawn before norepinephrine.