Imperial College London
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Professor Anthony Gordon

Faculty of Medicine, Department of Surgery & Cancer

Chair in Anaesthesia and Critical Care
 
 
 
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Contact

 

anthony.gordon

 
 
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Location

 

ICUQueen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{McIntyre:2018:10.1001/jama.2018.4528,
author = {McIntyre, WF and Um, KJ and Alhazzani, W and Lengyel, AP and Hajjar, L and Gordon, AC and Lamontagne, F and Healey, JS and Whitlock, RP and Belley-Cote, EP},
doi = {10.1001/jama.2018.4528},
journal = {Journal of the American Medical Association},
pages = {1889--1900},
title = {Association of Vasopressin Plus Catecholamine Vasopressors vs Catecholamines Alone With Atrial Fibrillation in Patients With Distributive Shock},
url = {http://dx.doi.org/10.1001/jama.2018.4528},
volume = {319},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Importance  Vasopressin is an alternative to catecholamine vasopressors for patients with distributive shock—a condition due to excessive vasodilation, most frequently from severe infection. Blood pressure support with a noncatecholamine vasopressor may reduce stimulation of adrenergic receptors and decrease myocardial oxygen demand. Atrial fibrillation is common with catecholamines and is associated with adverse events, including mortality and increased length of stay (LOS).Objectives  To determine whether treatment with vasopressin + catecholamine vasopressors compared with catecholamine vasopressors alone was associated with reductions in the risk of adverse events.Data Sources  MEDLINE, EMBASE, and CENTRAL were searched from inception to February 2018. Experts were asked and meta-registries searched to identify ongoing trials.Study Selection  Pairs of reviewers identified randomized clinical trials comparing vasopressin in combination with catecholamine vasopressors to catecholamines alone for patients with distributive shock.Data Extraction and Synthesis  Two reviewers abstracted data independently. A random-effects model was used to combine data.Main Outcomes and Measures  The primary outcome was atrial fibrillation. Other outcomes included mortality, requirement for renal replacement therapy (RRT), myocardial injury, ventricular arrhythmia, stroke, and LOS in the intensive care unit and hospital. Measures of association are reported as risk ratios (RRs) for clinical outcomes and mean differences for LOS.Results  Twenty-three randomized clinical trials were identified (3088 patients; mean age, 61.1 years [14.2]; women, 45.3%). High-quality evidence supported a lower risk of atrial fibrillation associated with vasopressin treatment (RR, 0.77 [95% CI, 0.67 to 0.88]; risk difference [RD], −0.06 [95% CI, −0.13 to 0.01]). For mortality, the overall RR estimate was 0.89 (95% CI, 0.82 to 0.97; RD, −0.04 [95% CI, −0.07 to 0.
AU  - McIntyre,WF
AU  - Um,KJ
AU  - Alhazzani,W
AU  - Lengyel,AP
AU  - Hajjar,L
AU  - Gordon,AC
AU  - Lamontagne,F
AU  - Healey,JS
AU  - Whitlock,RP
AU  - Belley-Cote,EP
DO  - 10.1001/jama.2018.4528
EP  - 1900
PY  - 2018///
SN  - 0098-7484
SP  - 1889
TI  - Association of Vasopressin Plus Catecholamine Vasopressors vs Catecholamines Alone With Atrial Fibrillation in Patients With Distributive Shock
T2  - Journal of the American Medical Association
UR  - http://dx.doi.org/10.1001/jama.2018.4528
UR  - http://hdl.handle.net/10044/1/58958
VL  - 319
ER  -
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