Clinical trials comparing norepinephrine with vasopressin in patients with septic shock: A meta-analysis

Fei-Hu Zhou; Qing Song

doi:10.1186/2054-9369-1-6

Your Location：

Home >

Browse articles >

Clinical trials comparing norepinephrine with vasopressin in patients with septic shock: A meta-analysis

RESEARCH | Updated：2026-03-12

- Clinical trials comparing norepinephrine with vasopressin in patients with septic shock: A meta-analysis
- Military Medical Research Vol. 1, Issue 1, Pages: 44-50(2014)
- Affiliations：
  
  Department of Critical Care Medicine, the Chinese PLA General Hospital, Beijing 100853, China
- Author bio：
  
  *: zhoufh301@126.com
- Funds：
- DOI：10.1186/2054-9369-1-6
  CLC：
- Published：2014-03
- Accepted：
Scan QR Code
Zhou et al.: Clinical trials comparing norepinephrine with vasopressin in patients with septic shock: A meta-analysis. Military Medical Research 2014, 1: 6
DOI：

Zhou et al.: Clinical trials comparing norepinephrine with vasopressin in patients with septic shock: A meta-analysis. Military Medical Research 2014, 1: 6 DOI： 10.1186/2054-9369-1-6.

摘要

Abstract

Background:

To compare the mortality rates and benefits of norepinephrine and vasopressin in patients with septic shock.

Methods:

PubMed

EMBASE

and the Cochrane Library database were searched from database inception to December 2013. We selected randomized controlled trials in adults with septic shock and compared norepinephrine with vasopressin. After assessing the heterogeneity of treatment effects across trials using the I2 statistic

we used a fixed effects model (

≥0.1) and expressed the results as risk ratios (RRs) for dichotomous outcomes or as standardized mean differences (SMDs) for continuous data with 95% confidence intervals (CIs). Meta-analysis was conducted using Review Manager 5.1 software.

Results:

Seven trials (

=2323) met the inclusion criteria. Overall

the mortality rate in these seven trials was 36.2% (840/2323). There was no difference in mortality following the use of norepinephrine or vasopressin (

1.07; 95%CI 0.97-1.20;

=0.19). Compared to norepinephrine

vasopressin had no significant effect on heart rate (HR) (SMD 0.21; 95%CI -0.08-0.50;

=0.15)

mean arterial pressure (MAP) (SMD 0.15; 95%CI -0.15-0.44;

=0.33)

cardiac index (CI) (SMD -0.10; 95%CI -0.64-0.44;

=0.73)

systemic vascular resistance index (SVRI) (SMD 0.15; 95%CI -0.39-0.70;

=0.58)

oxygen delivery (DO2) (SMD -0.06; 95%CI -0.62-0.49;

=0.82)

oxygen consumption (VO2) (SMD 0.03; 95%CI -0.52-0.59;

=0.91) or lactic acid (SMD 0.07; 95%CI -0.23-0.36;

=0.66). No significant heterogeneity was found in these comparisons (P≥0.1).

Conclusions:

There is not sufficient evidence to prove conclusively that norepinephrine is superior to vasopressin in terms of mortality and hemodynamics. The effects of norepinephrine and vasopressin on patients with septic shock require further study in large randomized controlled trials.

关键词

Keywords

references

Levy MM , Dellinger RP , Townsend SR , Linde-Zwirble WT , Marshall JC , Bion J , Schorr C , Artigas A , Ramsay G , Beale R , Parker MM , Gerlach H , Reinhart K , Silva E , Harvey M , Regan S , Angus DC : Surviving Sepsis Campaign: The surviving sepsis campaign: results of an international guideline-based performance improvement program targeting severe sepsis . Crit Care Med 2010 , 38 : 367 - 374 .

Angus DC , Linde-Zwirble WT , Lidicker J , Clermont G , Carcillo J , Pinsky MR : Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care . Crit Care Med 2001 , 29 : 1303 - 1310 .

Dellinger RP , Levy MM , Carlet JM , Bion J , Parker MM , Jaeschke R , Reinhart K , Angus DC , Brun-Buisson C , Beale R , Calandra T , Dhainaut JF , Gerlach H , Harvey M , Marini JJ , Marshall J , Ranieri M , Ramsay G , Sevransky J , Thompson BT , Townsend S , Vender JS , Zimmerman JL , Vincent JL ; International Surviving Sepsis Campaign Guidelines Committee ; American Association of Critical-Care Nurses ; American College of Chest Physicians ; American College of Emergency Physicians ; Canadian Critical Care Society ; European Society of Clinical Microbiology and Infectious Diseases ; European Society of Intensive Care Medicine ; European Respiratory Society ; International Sepsis Forum ; Japanese Association for Acute Medicine ; Japanese Society of Intensive Care Medicine ; Society of Critical Care Medicine ; Society of Hospital Medicine ; Surgical Infection Society ; World Federation of Societies of Intensive and Critical Care Medicine : Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008 . Crit Care Med 2008 , 36 : 296 - 327 .

De Backer D , Biston P , Devriendt J , Madl C , Chochrad D , Aldecoa C , Brasseur A , Defrance P , Gottignies P , Vincent JL ; SOAP II Investigators : Comparison of dopamine and norepinephrine in the treatment of shock . N Engl J Med 2010 , 362 : 779 - 789 .

Personett HA , Stollings JL , Cha SS , Oyen LJ : Predictors of prolonged vasopressin infusion for the treatment of septic shock . J Crit Care 2012 , 27 : 318.e7-12 .

Gordon AC , Wang N , Walley KR , Ashby D , Russell JA : The cardiopulmonary effects of vasopressin compared with norepinephrine in septic shock . Chest 2012 , 142 : 593 - 605 .

Daley MJ , Lat I , Mieure KD , Jennings HR , Hall JB , Kress JP : A comparison of initial monotherapy with norepinephrine versus vasopressin for resuscitation in septic shock . Ann Pharmacother 2013 , 47 : 301 - 310 .

Russell JA , Walley KR , Singer J , Gordon AC , Hébert PC , Cooper DJ , Holmes CL , Mehta S , Granton JT , Storms MM , Cook DJ , Presneill JJ , Ayers D ; VASST Investigators : Vasopressin versus norepinephrine infusion in patients with septic shock . N Engl J Med 2008 , 358 : 877 - 887 .

Moher D , Liberati A , Tetzlaff J , Altman DG ; PRISMA Group : Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement . Int J Surg 2010 , 8 : 336 - 341 .

Jadad AR , Moore RA , Carroll D , Jenkinson C , Reynolds DJ , Gavaghan DJ , McQuay HJ : Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996 , 17 : 1 - 12 .

Higgins JP , Thompson SG , Deeks JJ , Altman DG : Measuring inconsistency in meta-analyses . BMJ 2003 , 327 : 557 - 560 .

Russell JA , Fjell C , Hsu JL , Lee T , Boyd J , Thair S , Singer J , Patterson AJ , Walley KR : Vasopressin compared with norepinephrine augments the decline of plasma cytokine levels in septic shock . Am J Respir Crit Care Med 2013 , 188 : 356 - 364 .

Gordon AC , Russell JA , Walley KR , Singer J , Ayers D , Storms MM , Holmes CL , Hébert PC , Cooper DJ , Mehta S , Granton JT , Cook DJ , Presneill JJ : The effects of vasopressin on acute kidney injury in septic shock . Intensive Care Med 2010 , 36 : 83 - 91 .

Russell JA , Walley KR , Gordon AC , Cooper DJ , Hébert PC , Singer J , Holmes CL , Mehta S , Granton JT , Storms MM , Cook DJ , Presneill JJ ; Dieter Ayers for the Vasopressin and Septic Shock Trial Investigators : Interaction of vasopressin infusion, corticosteroid treatment, and mortality of septic shock . Crit Care Med 2009 , 37 : 811 - 818 .

Morelli A , Ertmer C , Rehberg S , Lange M , Orecchioni A , Cecchini V , Bachetoni A , D’Alessandro M , Van Aken H , Pietropaoli P , Westphal M : Continuous terlipressin versus vasopressin infusion in septic shock (TERLIVAP): a randomized, controlled pilot study . Crit Care 2009 , 13 : R130 .

Lauzier F , Lévy B , Lamarre P , Lesur O : Vasopressin or norepinephrine in early hyperdynamic septic shock: a randomized clinical trial . Intensive Care Med 2006 , 32 : 1782 - 1789 .

Bone RC , Balk RA , Cerra FB , Dellinger RP , Fein AM , Knaus WA , Schein RM , Sibbald WJ : Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine . Chest 1992 , 101 : 1644 - 1655 .

Hollenberg SM : Inotrope and vasopressor therapy of septic shock . Crit Care Clin 2009 , 25 : 781 - 802 .

Parrillo JE : Septic shock-vasopressin, norepinephrine, and urgency . N Engl J Med 2008 , 358 : 954 - 956 .

Leone M , Martin C : Vasopressor use in septic shock: an update . Curr Opin Anaesthesiol 2008 , 21 : 141 - 147 .

Guérin JP , Levraut J , Samat-Long C , Leverve X , Grimaud D , Ichai C : Effects of dopamine and norepinephrine on systemic and hepatosplanchnic hemodynamics, oxygen exchange, and energy balance in vasoplegic septic patients . Shock 2005 , 23 : 18 - 24 .

Murphey ED , Traber DL : Cardiopulmonary and splanchnic blood flow during48 hours of a continuous infusion of endotoxin in conscious pigs: a model of hyperdyanmic shock . Shock 2000 , 13 : 224 - 229 .

Träger K , Radermacher P , Rieger KM , Vlatten A , Vogt J , Iber T , Adler J , Wachter U , Grover R , Georgieff Santak B : Norepinephrine and N*-monomethyl-Larginine in porcine septic shock. Effects on hepatic O2 exchange and energy balance . Am J Respir Crit Care Med 1999 , 159 : 1758 - 1765 .

Meier-Hellmann A , Specht M , Hannemann L , Hassel H , Bredle DL , Reinhart K : Splanchnic blood flow is greater in septic shock treated with norepinephrine than in severe sepsis . Intensive Care Med 1996 , 22 : 1354 - 1359 .

De Backer D , Zhang H , Cherkhaoui S , Borgers M , Vincent JL : Effects of dobutamine on hepato-splanchnic hemodynamics in an experimental model of hyperdynamic endotoxic shock . Shock 2001 , 15 : 208 - 214 .

Views

Downloads

CSCD

Alert me when the article has been cited

Submit

Tools

Publicity Resources

Regulatory mechanisms, prophylaxis and treatment of vascular leakage following severe trauma and shock

Exosomal mediators in sepsis and inflammatory organ injury: unraveling the role of exosomes in intercellular crosstalk and organ dysfunction

Repurposing a detrimental antibody epitope as targeted therapeutics for sepsis and rheumatoid arthritis

The "cytokine storm" in infection and sepsis:win the battle but lose the war

Sepsis in burns: lessons learned, challenges remain

Related Author

Chen-Yang Duan

Jie Zhang

Hui-Ling Wu

Tao Li

Liang-Ming Liu

Ting Gong

You-Tan Liu

Jie Fan

Related Institution

State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University

Department of Surgery, University of Pittsburgh School of Medicine

Department of Anesthesiology, Shenzhen Hospital, Southern Medical University

Research and Development, Veterans Affairs Pittsburgh Healthcare System

Department of Immunology, University of Pittsburgh School of Medicine

⁰