• Can J Anaesth · Mar 2020

    Practice Guideline

    Canadian Critical Care Society clinical practice guideline: The use of vasopressin and vasopressin analogues in critically ill adults with distributive shock.

    • Kimia Honarmand, Kevin John Um, Emilie P Belley-Côté, Waleed Alhazzani, Chris Farley, Shannon M Fernando, Kirsten Fiest, Donna Grey, Edita Hajdini, Margaret Herridge, Carmen Hrymak, MøllerMorten HylanderMHDepartment of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark.Centre for Research in Intensive Care, Copenhagen, Denmark., Salmaan Kanji, François Lamontagne, François Lauzier, Sangeeta Mehta, Bojan Paunovic, Rohit Singal, Jennifer Ly Tsang, Christine Wynne, and Bram Rochwerg.
    • Division of Critical Care, Department of Medicine, Western University, London, ON, Canada.
    • Can J Anaesth. 2020 Mar 1; 67 (3): 369376369-376.

    PurposeHemodynamic 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.MethodsWe 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.ResultsThe 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).ConclusionsAfter 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).

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