Canadian Critical Care Society clinical practice guideline: The use of vasopressin and vasopressin analogues in critically ill adults with distributive shock
Purpose Hemodynamic management of adults with distributive shock often includes the use of catecholamine-based vasoconstricting medications. It is unclear whether adding vasopressin or vasopressin analogues to catecholamine therapy is beneficial in the management of patients with distributive shock....
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| Veröffentlicht in: | Canadian journal of anesthesia 2020-03, Vol.67 (3), p.369-376 |
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| creator | Honarmand, Kimia Um, Kevin John Belley-Côté, Emilie P. Alhazzani, Waleed Farley, Chris Fernando, Shannon M. Fiest, Kirsten Grey, Donna Hajdini, Edita Herridge, Margaret Hrymak, Carmen Møller, Morten Hylander Kanji, Salmaan Lamontagne, François Lauzier, François Mehta, Sangeeta Paunovic, Bojan Singal, Rohit Tsang, Jennifer Ly Wynne, Christine Rochwerg, Bram |
| description | Purpose
Hemodynamic management of adults with distributive shock often includes the use of catecholamine-based vasoconstricting medications. It is unclear whether adding vasopressin or vasopressin analogues to catecholamine therapy is beneficial in the management of patients with distributive shock. The purpose of this guideline was to develop an evidence-based recommendation regarding the addition of vasopressin to catecholamine vasopressors in the management of adults with distributive shock.
Methods
We summarized the evidence informing this recommendation by updating a recently published meta-analysis. Then, a multidisciplinary panel from the Canadian Critical Care Society developed the recommendation using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.
Results
The updated systematic review identified 25 randomized controlled trials including a total of 3,737 patients with distributive shock. Compared with catecholamine therapy alone, the addition of vasopressin or its analogues was associated with a reduced risk of mortality (relative risk [RR], 0.91; 95% confidence interval [CI], 0.85 to 0.99; low certainty), reduced risk of atrial fibrillation (RR, 0.77; 95% CI, 0.67 to 0.88; high certainty), and increased risk of digital ischemia (RR, 2.56; 95% CI, 1.24 to 5.25; moderate certainty).
Conclusions
After considering certainty in the evidence, values and preferences, cost, and other factors, the expert guideline panel suggests using vasopressin or vasopressin analogues in addition to catecholamines over catecholamine vasopressors alone for the management of distributive shock (conditional recommendation, low certainty evidence). |
| doi_str_mv | 10.1007/s12630-019-01546-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2321665706</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2348753806</sourcerecordid><originalsourceid>FETCH-LOGICAL-c447t-8d37be06d55bc5d1b6f1f71786ab882074c9ea1192557106c97c06357a1b0e2b3</originalsourceid><addsrcrecordid>eNp9kc9u1DAQxi0EotuFF-CALHHhEjqO4z_hhiJakCr1QJG4WY4z2XXxJoudtN2H4V1rdheQeujBsmbm931j6yPkDYMPDECdJVZKDgWwOh9RyeL-GVmwqpaFrpV4ThageVlIBj9OyGlKNwCgpdAvyQlnqlYlrxbkd2MH23k70Cb6yTsbaGMj0m-j8zjtqAt-2He30bo8R7qafYe5ix_p9RrpnJCOPb21adxGTMkP1A7do9qGcTVjorlwxzVhR30I1HZzmBK989Oadj5N0bfz5G-RpvXofr4iL3obEr4-3kvy_fzzdfOluLy6-Np8uixcVamp0B1XLYLshGid6Fgre9YrprS0rdYlqMrVaBmrSyEUA-lq5UByoSxrAcuWL8n7g-82jr_yQyez8clhCHbAcU6m5CWTUqgsWpJ3j9CbcY75h5mqQYKoQPEnKV5pJbjee5UHysUxpYi92Ua_sXFnGJg_EZtDxCZHbPYRm_ssenu0ntsNdv8kfzPNAD8AKY-GFcb_u5-wfQBkwrOY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2348753806</pqid></control><display><type>article</type><title>Canadian Critical Care Society clinical practice guideline: The use of vasopressin and vasopressin analogues in critically ill adults with distributive shock</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Honarmand, Kimia ; Um, Kevin John ; Belley-Côté, Emilie P. ; Alhazzani, Waleed ; Farley, Chris ; Fernando, Shannon M. ; Fiest, Kirsten ; Grey, Donna ; Hajdini, Edita ; Herridge, Margaret ; Hrymak, Carmen ; Møller, Morten Hylander ; Kanji, Salmaan ; Lamontagne, François ; Lauzier, François ; Mehta, Sangeeta ; Paunovic, Bojan ; Singal, Rohit ; Tsang, Jennifer Ly ; Wynne, Christine ; Rochwerg, Bram</creator><creatorcontrib>Honarmand, Kimia ; Um, Kevin John ; Belley-Côté, Emilie P. ; Alhazzani, Waleed ; Farley, Chris ; Fernando, Shannon M. ; Fiest, Kirsten ; Grey, Donna ; Hajdini, Edita ; Herridge, Margaret ; Hrymak, Carmen ; Møller, Morten Hylander ; Kanji, Salmaan ; Lamontagne, François ; Lauzier, François ; Mehta, Sangeeta ; Paunovic, Bojan ; Singal, Rohit ; Tsang, Jennifer Ly ; Wynne, Christine ; Rochwerg, Bram</creatorcontrib><description>Purpose
Hemodynamic management of adults with distributive shock often includes the use of catecholamine-based vasoconstricting medications. It is unclear whether adding vasopressin or vasopressin analogues to catecholamine therapy is beneficial in the management of patients with distributive shock. The purpose of this guideline was to develop an evidence-based recommendation regarding the addition of vasopressin to catecholamine vasopressors in the management of adults with distributive shock.
Methods
We summarized the evidence informing this recommendation by updating a recently published meta-analysis. Then, a multidisciplinary panel from the Canadian Critical Care Society developed the recommendation using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.
Results
The updated systematic review identified 25 randomized controlled trials including a total of 3,737 patients with distributive shock. Compared with catecholamine therapy alone, the addition of vasopressin or its analogues was associated with a reduced risk of mortality (relative risk [RR], 0.91; 95% confidence interval [CI], 0.85 to 0.99; low certainty), reduced risk of atrial fibrillation (RR, 0.77; 95% CI, 0.67 to 0.88; high certainty), and increased risk of digital ischemia (RR, 2.56; 95% CI, 1.24 to 5.25; moderate certainty).
Conclusions
After considering certainty in the evidence, values and preferences, cost, and other factors, the expert guideline panel suggests using vasopressin or vasopressin analogues in addition to catecholamines over catecholamine vasopressors alone for the management of distributive shock (conditional recommendation, low certainty evidence).</description><identifier>ISSN: 0832-610X</identifier><identifier>EISSN: 1496-8975</identifier><identifier>DOI: 10.1007/s12630-019-01546-x</identifier><identifier>PMID: 31797234</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Adults ; Anesthesiology ; Blood pressure ; Canada ; Cardiac arrhythmia ; Cardiology ; Catecholamines ; Clinical medicine ; Clinical practice guidelines ; Critical Care ; Critical Care Medicine ; Critical Illness ; Emergency medical care ; Health sciences ; Humans ; Intensive ; Intensive care ; Medical research ; Medicine ; Medicine & Public Health ; Mortality ; Pain Medicine ; Pediatrics ; Pneumology/Respiratory System ; Research methodology ; Sepsis ; Shock - drug therapy ; Special Article ; Vasopressins - therapeutic use</subject><ispartof>Canadian journal of anesthesia, 2020-03, Vol.67 (3), p.369-376</ispartof><rights>Canadian Anesthesiologists' Society 2019. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>Canadian Journal of Anesthesia is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c447t-8d37be06d55bc5d1b6f1f71786ab882074c9ea1192557106c97c06357a1b0e2b3</citedby><cites>FETCH-LOGICAL-c447t-8d37be06d55bc5d1b6f1f71786ab882074c9ea1192557106c97c06357a1b0e2b3</cites><orcidid>0000-0002-8293-7061</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12630-019-01546-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12630-019-01546-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31797234$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Honarmand, Kimia</creatorcontrib><creatorcontrib>Um, Kevin John</creatorcontrib><creatorcontrib>Belley-Côté, Emilie P.</creatorcontrib><creatorcontrib>Alhazzani, Waleed</creatorcontrib><creatorcontrib>Farley, Chris</creatorcontrib><creatorcontrib>Fernando, Shannon M.</creatorcontrib><creatorcontrib>Fiest, Kirsten</creatorcontrib><creatorcontrib>Grey, Donna</creatorcontrib><creatorcontrib>Hajdini, Edita</creatorcontrib><creatorcontrib>Herridge, Margaret</creatorcontrib><creatorcontrib>Hrymak, Carmen</creatorcontrib><creatorcontrib>Møller, Morten Hylander</creatorcontrib><creatorcontrib>Kanji, Salmaan</creatorcontrib><creatorcontrib>Lamontagne, François</creatorcontrib><creatorcontrib>Lauzier, François</creatorcontrib><creatorcontrib>Mehta, Sangeeta</creatorcontrib><creatorcontrib>Paunovic, Bojan</creatorcontrib><creatorcontrib>Singal, Rohit</creatorcontrib><creatorcontrib>Tsang, Jennifer Ly</creatorcontrib><creatorcontrib>Wynne, Christine</creatorcontrib><creatorcontrib>Rochwerg, Bram</creatorcontrib><title>Canadian Critical Care Society clinical practice guideline: The use of vasopressin and vasopressin analogues in critically ill adults with distributive shock</title><title>Canadian journal of anesthesia</title><addtitle>Can J Anesth/J Can Anesth</addtitle><addtitle>Can J Anaesth</addtitle><description>Purpose
Hemodynamic management of adults with distributive shock often includes the use of catecholamine-based vasoconstricting medications. It is unclear whether adding vasopressin or vasopressin analogues to catecholamine therapy is beneficial in the management of patients with distributive shock. The purpose of this guideline was to develop an evidence-based recommendation regarding the addition of vasopressin to catecholamine vasopressors in the management of adults with distributive shock.
Methods
We summarized the evidence informing this recommendation by updating a recently published meta-analysis. Then, a multidisciplinary panel from the Canadian Critical Care Society developed the recommendation using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.
Results
The updated systematic review identified 25 randomized controlled trials including a total of 3,737 patients with distributive shock. Compared with catecholamine therapy alone, the addition of vasopressin or its analogues was associated with a reduced risk of mortality (relative risk [RR], 0.91; 95% confidence interval [CI], 0.85 to 0.99; low certainty), reduced risk of atrial fibrillation (RR, 0.77; 95% CI, 0.67 to 0.88; high certainty), and increased risk of digital ischemia (RR, 2.56; 95% CI, 1.24 to 5.25; moderate certainty).
Conclusions
After considering certainty in the evidence, values and preferences, cost, and other factors, the expert guideline panel suggests using vasopressin or vasopressin analogues in addition to catecholamines over catecholamine vasopressors alone for the management of distributive shock (conditional recommendation, low certainty evidence).</description><subject>Adult</subject><subject>Adults</subject><subject>Anesthesiology</subject><subject>Blood pressure</subject><subject>Canada</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Catecholamines</subject><subject>Clinical medicine</subject><subject>Clinical practice guidelines</subject><subject>Critical Care</subject><subject>Critical Care Medicine</subject><subject>Critical Illness</subject><subject>Emergency medical care</subject><subject>Health sciences</subject><subject>Humans</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Pain Medicine</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Research methodology</subject><subject>Sepsis</subject><subject>Shock - drug therapy</subject><subject>Special Article</subject><subject>Vasopressins - therapeutic use</subject><issn>0832-610X</issn><issn>1496-8975</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kc9u1DAQxi0EotuFF-CALHHhEjqO4z_hhiJakCr1QJG4WY4z2XXxJoudtN2H4V1rdheQeujBsmbm931j6yPkDYMPDECdJVZKDgWwOh9RyeL-GVmwqpaFrpV4ThageVlIBj9OyGlKNwCgpdAvyQlnqlYlrxbkd2MH23k70Cb6yTsbaGMj0m-j8zjtqAt-2He30bo8R7qafYe5ix_p9RrpnJCOPb21adxGTMkP1A7do9qGcTVjorlwxzVhR30I1HZzmBK989Oadj5N0bfz5G-RpvXofr4iL3obEr4-3kvy_fzzdfOluLy6-Np8uixcVamp0B1XLYLshGid6Fgre9YrprS0rdYlqMrVaBmrSyEUA-lq5UByoSxrAcuWL8n7g-82jr_yQyez8clhCHbAcU6m5CWTUqgsWpJ3j9CbcY75h5mqQYKoQPEnKV5pJbjee5UHysUxpYi92Ua_sXFnGJg_EZtDxCZHbPYRm_ssenu0ntsNdv8kfzPNAD8AKY-GFcb_u5-wfQBkwrOY</recordid><startdate>20200301</startdate><enddate>20200301</enddate><creator>Honarmand, Kimia</creator><creator>Um, Kevin John</creator><creator>Belley-Côté, Emilie P.</creator><creator>Alhazzani, Waleed</creator><creator>Farley, Chris</creator><creator>Fernando, Shannon M.</creator><creator>Fiest, Kirsten</creator><creator>Grey, Donna</creator><creator>Hajdini, Edita</creator><creator>Herridge, Margaret</creator><creator>Hrymak, Carmen</creator><creator>Møller, Morten Hylander</creator><creator>Kanji, Salmaan</creator><creator>Lamontagne, François</creator><creator>Lauzier, François</creator><creator>Mehta, Sangeeta</creator><creator>Paunovic, Bojan</creator><creator>Singal, Rohit</creator><creator>Tsang, Jennifer Ly</creator><creator>Wynne, Christine</creator><creator>Rochwerg, Bram</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8293-7061</orcidid></search><sort><creationdate>20200301</creationdate><title>Canadian Critical Care Society clinical practice guideline: The use of vasopressin and vasopressin analogues in critically ill adults with distributive shock</title><author>Honarmand, Kimia ; Um, Kevin John ; Belley-Côté, Emilie P. ; Alhazzani, Waleed ; Farley, Chris ; Fernando, Shannon M. ; Fiest, Kirsten ; Grey, Donna ; Hajdini, Edita ; Herridge, Margaret ; Hrymak, Carmen ; Møller, Morten Hylander ; Kanji, Salmaan ; Lamontagne, François ; Lauzier, François ; Mehta, Sangeeta ; Paunovic, Bojan ; Singal, Rohit ; Tsang, Jennifer Ly ; Wynne, Christine ; Rochwerg, Bram</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c447t-8d37be06d55bc5d1b6f1f71786ab882074c9ea1192557106c97c06357a1b0e2b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Adults</topic><topic>Anesthesiology</topic><topic>Blood pressure</topic><topic>Canada</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Catecholamines</topic><topic>Clinical medicine</topic><topic>Clinical practice guidelines</topic><topic>Critical Care</topic><topic>Critical Care Medicine</topic><topic>Critical Illness</topic><topic>Emergency medical care</topic><topic>Health sciences</topic><topic>Humans</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Pain Medicine</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Research methodology</topic><topic>Sepsis</topic><topic>Shock - drug therapy</topic><topic>Special Article</topic><topic>Vasopressins - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Honarmand, Kimia</creatorcontrib><creatorcontrib>Um, Kevin John</creatorcontrib><creatorcontrib>Belley-Côté, Emilie P.</creatorcontrib><creatorcontrib>Alhazzani, Waleed</creatorcontrib><creatorcontrib>Farley, Chris</creatorcontrib><creatorcontrib>Fernando, Shannon M.</creatorcontrib><creatorcontrib>Fiest, Kirsten</creatorcontrib><creatorcontrib>Grey, Donna</creatorcontrib><creatorcontrib>Hajdini, Edita</creatorcontrib><creatorcontrib>Herridge, Margaret</creatorcontrib><creatorcontrib>Hrymak, Carmen</creatorcontrib><creatorcontrib>Møller, Morten Hylander</creatorcontrib><creatorcontrib>Kanji, Salmaan</creatorcontrib><creatorcontrib>Lamontagne, François</creatorcontrib><creatorcontrib>Lauzier, François</creatorcontrib><creatorcontrib>Mehta, Sangeeta</creatorcontrib><creatorcontrib>Paunovic, Bojan</creatorcontrib><creatorcontrib>Singal, Rohit</creatorcontrib><creatorcontrib>Tsang, Jennifer Ly</creatorcontrib><creatorcontrib>Wynne, Christine</creatorcontrib><creatorcontrib>Rochwerg, Bram</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Canadian Business & Current Affairs Database</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Canadian journal of anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Honarmand, Kimia</au><au>Um, Kevin John</au><au>Belley-Côté, Emilie P.</au><au>Alhazzani, Waleed</au><au>Farley, Chris</au><au>Fernando, Shannon M.</au><au>Fiest, Kirsten</au><au>Grey, Donna</au><au>Hajdini, Edita</au><au>Herridge, Margaret</au><au>Hrymak, Carmen</au><au>Møller, Morten Hylander</au><au>Kanji, Salmaan</au><au>Lamontagne, François</au><au>Lauzier, François</au><au>Mehta, Sangeeta</au><au>Paunovic, Bojan</au><au>Singal, Rohit</au><au>Tsang, Jennifer Ly</au><au>Wynne, Christine</au><au>Rochwerg, Bram</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Canadian Critical Care Society clinical practice guideline: The use of vasopressin and vasopressin analogues in critically ill adults with distributive shock</atitle><jtitle>Canadian journal of anesthesia</jtitle><stitle>Can J Anesth/J Can Anesth</stitle><addtitle>Can J Anaesth</addtitle><date>2020-03-01</date><risdate>2020</risdate><volume>67</volume><issue>3</issue><spage>369</spage><epage>376</epage><pages>369-376</pages><issn>0832-610X</issn><eissn>1496-8975</eissn><abstract>Purpose
Hemodynamic management of adults with distributive shock often includes the use of catecholamine-based vasoconstricting medications. It is unclear whether adding vasopressin or vasopressin analogues to catecholamine therapy is beneficial in the management of patients with distributive shock. The purpose of this guideline was to develop an evidence-based recommendation regarding the addition of vasopressin to catecholamine vasopressors in the management of adults with distributive shock.
Methods
We summarized the evidence informing this recommendation by updating a recently published meta-analysis. Then, a multidisciplinary panel from the Canadian Critical Care Society developed the recommendation using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.
Results
The updated systematic review identified 25 randomized controlled trials including a total of 3,737 patients with distributive shock. Compared with catecholamine therapy alone, the addition of vasopressin or its analogues was associated with a reduced risk of mortality (relative risk [RR], 0.91; 95% confidence interval [CI], 0.85 to 0.99; low certainty), reduced risk of atrial fibrillation (RR, 0.77; 95% CI, 0.67 to 0.88; high certainty), and increased risk of digital ischemia (RR, 2.56; 95% CI, 1.24 to 5.25; moderate certainty).
Conclusions
After considering certainty in the evidence, values and preferences, cost, and other factors, the expert guideline panel suggests using vasopressin or vasopressin analogues in addition to catecholamines over catecholamine vasopressors alone for the management of distributive shock (conditional recommendation, low certainty evidence).</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31797234</pmid><doi>10.1007/s12630-019-01546-x</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-8293-7061</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Canadian journal of anesthesia, 2020-03, Vol.67 (3), p.369-376 |
| issn | 0832-610X 1496-8975 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Adults Anesthesiology Blood pressure Canada Cardiac arrhythmia Cardiology Catecholamines Clinical medicine Clinical practice guidelines Critical Care Critical Care Medicine Critical Illness Emergency medical care Health sciences Humans Intensive Intensive care Medical research Medicine Medicine & Public Health Mortality Pain Medicine Pediatrics Pneumology/Respiratory System Research methodology Sepsis Shock - drug therapy Special Article Vasopressins - therapeutic use |
| title | Canadian Critical Care Society clinical practice guideline: The use of vasopressin and vasopressin analogues in critically ill adults with distributive shock |
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