SynthesisCritical care (London, England)2012
Vasopressin and terlipressin in adult vasodilatory shock: a systematic review and meta-analysis of nine randomized controlled trials.
Synthesis in Critical care (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers, 12 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
49 citing papers in PubMed, 12 syntheses or guidelines pooled it, 130 citations in OpenAlex.
- The effects of vasopressor choice on renal outcomes in septic shock: a systematic review of randomised trials as a guide for future research.Critical care (London, England) · 2025Pooled it
- Terlipressin for the treatment of septic shock in adults: a systematic review and meta-analysis.BMC anesthesiology · 2020Pooled it
- Clinical Efficiency of Vasopressin or Its Analogs in Comparison With Catecholamines Alone on Patients With Septic Shock: A Systematic Review and Meta-Analysis.Frontiers in pharmacology · 2020Pooled it
- Comparative efficacy of vasoactive medications in patients with septic shock: a network meta-analysis of randomized controlled trials.Critical care (London, England) · 2019Pooled it
- The effects and safety of vasopressin receptor agonists in patients with septic shock: a meta-analysis and trial sequential analysis.Critical care (London, England) · 2019Pooled it
- Terlipressin Versus Norepinephrine for Septic Shock: A Systematic Review and Meta-Analysis.Frontiers in pharmacology · 2019Pooled it
- [S3 guidelines on intensive medical care of cardiac surgery patients : Hemodynamic monitoring and cardiovascular system-an update].Der Anaesthesist · 2018Guideline
- A Systematic Review of Neuroprotective Strategies during Hypovolemia and Hemorrhagic Shock.International journal of molecular sciences · 2017Pooled it
- Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017 : Expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine.Intensive care medicine · 2017Pooled it
- Scandinavian SSAI clinical practice guideline on choice of first-line vasopressor for patients with acute circulatory failure.Acta anaesthesiologica Scandinavica · 2016Pooled it
- Pooled it
- Small studies may overestimate the effect sizes in critical care meta-analyses: a meta-epidemiological study.Critical care (London, England) · 2013Pooled it
- Protocol for a randomised controlled trial of VAsopressin versus Noradrenaline as Initial therapy in Septic sHock (VANISH).BMJ open · 2014Trial
- Perioperative management of vasoplegic syndrome in cardiac surgery: a narrative review.Annals of medicine and surgery (2012) · 2026Review
- Pathophysiology and Perioperative Considerations for Heart Failure Patients.Life (Basel, Switzerland) · 2026Review
- Pharmacologic Strategies for Intraoperative Hypotension When Ephedrine Is Unavailable: An Evidence-Based Review.Journal of personalized medicine · 2026Review
- Review
- Article
- Vasopressin Initiation Timing and In-Hospital Mortality in Septic Shock: An Observational Study of Large Public Databases.Critical care explorations · 2025Observational
- Insights Into the Pathophysiology of Catecholamine-Refractory Shock: A Narrative Review.Cureus · 2025Review
Corrections and comments
- Commented on by
Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionCatecholamines are the most used vasopressors in vasodilatory shock. However, the development of adrenergic hyposensitivity and the subsequent loss of catecholamine pressor activity necessitate the search for other options. Our aim was to evaluate the effects of vasopressin and its analog terlipressin compared with catecholamine infusion alone in vasodilatory shock.
methodsA systematic review and meta-analysis of publications between 1966 and 2011 was performed. The Medline and CENTRAL databases were searched for studies on vasopressin and terlipressin in critically ill patients. The meta-analysis was limited to randomized controlled trials evaluating the use of vasopressin and/or terlipressin compared with catecholamine in adult patients with vasodilatory shock. The assessed outcomes were: overall survival, changes in the hemodynamic and biochemical variables, a decrease of catecholamine requirements, and adverse events.
resultsNine trials covering 998 participants were included. A meta-analysis using a fixed-effect model showed a reduction in norepinephrine requirement among patients receiving terlipressin or vasopressin infusion compared with control (standardized mean difference, -1.58 (95% confidence interval, -1.73 to -1.44); P < 0.0001). Overall, vasopressin and terlipressin, as compared with norepinephrine, reduced mortality (relative risk (RR), 0.87 (0.77 to 0.99); P = 0.04). Vasopressin compared with norepinephrine decreased mortality in adult patients (RR, 0.87 (0.76 to 1.00); P = 0.05) and in patients with septic shock (42.5% vs. 49.2%, respectively; RR, 0.87 (0.75 to 1.00); P = 0.05; number needed to treat, 1 to 15). There was no difference in adverse events between the vasopressin and control groups (RR, 0.98 (0.65 to 1.47); P = 0.92).
conclusionsVasopressin use in vasodilatory shock is safe, associated with reduced mortality, and facilitates weaning of catecholamines. In patients with septic shock, use of vasopressin compared with norepinephrine may also decrease mortality.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.