• Alessandro Belletti, Umberto Benedetto, Giuseppe Biondi-Zoccai, Carlo Leggieri, Paolo Silvani, Gianni D Angelini, Alberto Zangrillo, and Giovanni Landoni.
• Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: belletti.ale@gmail.com.
• J Crit Care. 2017 Feb 1; 37: 91-98.

PurposeInotropes 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 MethodsPubMed, BioMedCentral, Embase, and the Cochrane Central Register were searched. Randomized trials performed in septic patients with at least 1 group allocated to an inotrope/vasopressor were included. Network meta-analysis with a frequentist approach was performed.ResultsThe 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, 0.4; 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.ConclusionsAmong several regimens for pharmacological cardiovascular support in septic patients, regimens based on inodilators have the highest probability of improve survival.Copyright © 2016 Elsevier Inc. All rights reserved.

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