SynthesisBMJ open2017
Early vasopressor use following traumatic injury: a systematic review.
Synthesis in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 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
21 citing papers in PubMed, 2 syntheses or guidelines pooled it, 59 citations in OpenAlex.
- The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition.Critical care (London, England) · 2023Guideline
- Worldwide management of donors after neurological death: a systematic review and narrative synthesis of guidelines.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2020Pooled it
- Key strategies in trauma anesthesia for severe hemorrhage: a narrative review.Korean journal of anesthesiology · 2026Review
- Prehospital transfusion strategies in haemorrhagic shock.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Review
- Effect of different factors on predicting patient mortality beyond the NACA classification: a multivariate analysis of more than 2,000 polytrauma patients.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Are crystalloid-based fluid expansion strategies still relevant in the first hours of trauma induced hemorrhagic shock?Critical care (London, England) · 2024Review
- Eight rules for the haemodynamic management of traumatic brain-injured patients.European journal of anaesthesiology and intensive care · 2023Article
- A call for disciplined patience instead of crystalloid infusion for the trauma patient.Journal of military, veteran and family health · 2023Article
- Association of Early Norepinephrine Administration With 24-Hour Mortality Among Patients With Blunt Trauma and Hemorrhagic Shock.JAMA network open · 2022Observational
- Effects of norepinephrine infusion on cerebral energy metabolism during experimental haemorrhagic shock.Intensive care medicine experimental · 2022Article
- Low-dose norepinephrine in combination with hypotensive resuscitation may prolong the golden window for uncontrolled hemorrhagic shock in rats.Frontiers in physiology · 2022Article
- Norepinephrine potentiates the efficacy of volume expansion on mean systemic pressure in septic shock.Critical care (London, England) · 2021Article
- Severe traumatic brain injury and hypotension is a frequent and lethal combination in multiple trauma patients in mountain areas - an analysis of the prospective international Alpine Trauma Registry.Scandinavian journal of trauma, resuscitation and emergency medicine · 2021Article
- Multiple trauma management in mountain environments - a scoping review : Evidence based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Intended for physicians and other advanced life support personnel.Scandinavian journal of trauma, resuscitation and emergency medicine · 2020Article
- Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2020Article
- The impact of early administration of vasopressor agents for the resuscitation of severe hemorrhagic shock following blunt trauma.BMC emergency medicine · 2020Article
- Risk factors for death of trauma patients admitted to an Intensive Care Unit.Revista latino-americana de enfermagem · 2020Article
- ECMO with vasopressor use during early endotoxic shock: Can it improve circulatory support and regional microcirculatory blood flow?PloS one · 2019Article
- The potential roles of dopamine in traumatic brain injury: a preclinical and clinical update.American journal of translational research · 2019Review
- Fluid sparing and norepinephrine use in a rat model of resuscitated haemorrhagic shock: end-organ impact.Intensive care medicine experimental · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
22 authors at 15 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesCurrent guidelines suggest limiting the use of vasopressors following traumatic injury; however, wide variations in practice exist. Although excessive vasoconstriction may be harmful, these agents may help reduce administration of potentially harmful resuscitation fluids. This systematic review aims to compare early vasopressor use to standard resuscitation in adults with trauma-induced shock.
designSystematic review. DATA SOURCES: We searched MEDLINE, EMBASE, ClinicalTrials.gov and the Central Register of Controlled Trials from inception until October 2016, as well as the proceedings of 10 relevant international conferences from 2005 to 2016. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials and controlled observational studies that compared the early vasopressor use with standard resuscitation in adults with acute traumatic injury.
resultsOf 8001 citations, we retrieved 18 full-text articles and included 6 studies (1 randomised controlled trial and 5 observational studies), including 2 published exclusively in abstract form. Across observational studies, vasopressor use was associated with increased short-term mortality, with unadjusted risk ratios ranging from 2.31 to 7.39. However, the risk of bias was considered high in these observational studies because patients who received vasopressors were systematically sicker than patients treated without vasopressors. One clinical trial (n=78) was too imprecise to yield meaningful results. Two clinical trials are currently ongoing. No study measured long-term quality of life or cognitive function.
conclusionsExisting data on the effects of vasopressors following traumatic injury are of very low quality according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. With emerging evidence of harm associated with aggressive fluid resuscitation and, in selected subgroups of patients, with permissive hypotension, the alternatives to vasopressor therapy are limited. Observational data showing that vasopressors are part of usual care would provide a strong justification for high-quality clinical trials of early vasopressor use during trauma resuscitation. TRIAL REGISTRATION NUMBER: CRD42016033437.
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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.