SynthesisCritical care (London, England)2024
Non-adrenergic vasopressors for vasodilatory shock or perioperative vasoplegia: a meta-analysis of randomized controlled trials.
Synthesis in Critical care (London, England), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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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.
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Who cites it
12 citing papers in PubMed.
- Early multimodal vasopressor strategy in septic shock: results of the TRICYCLE randomized controlled trial.Critical care (London, England) · 2026Trial
- Adjunctive terlipressin versus placebo in the treatment of refractory septic shock: a randomized, placebo-controlled trial.Critical care (London, England) · 2025Trial
- Optimizing Timing and Dose of Starting Norepinephrine and Vasopressin in Septic Shock.Life (Basel, Switzerland) · 2026Review
- Modulation of the Vasopressin System in Distributive and Cardiogenic Shock: Theoretical Principles and Practical Applications.Journal of clinical medicine · 2026Review
- Perioperative Vasopressor Management in Noncardiac Surgical Patients.Anesthesiology · 2026Article
- Septic shock in the era of precision medicine: rethinking fluids, vasopressors, and immunomodulation.Frontiers in medicine · 2026Review
- Unnecessary fluid therapy in patients with shock: Five classic fluid pitfalls and five ways to do it better.Annals of intensive care · 2026Review
- Hydroxocobalamin for vasoplegia in cardiac surgery: a retrospective cohort analysis.British journal of anaesthesia · 2025Article
- Renal perfusion pressure: role and implications in critical illness.Annals of intensive care · 2025Review
- Vasopressin and its analogues in patients with septic shock: holy Grail or unfulfilled promise?Critical care (London, England) · 2025Review
- Insights Into the Pathophysiology of Catecholamine-Refractory Shock: A Narrative Review.Cureus · 2025Review
- Vasoplegic syndrome in cardiac surgery: bridging therapeutic gaps with best practices and future research.Interdisciplinary cardiovascular and thoracic surgery · 2025Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundExcessive exposure to adrenergic vasopressors may be harmful. Non-adrenergic vasopressors may spare adrenergic agents and potentially improve outcomes. We aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of non-adrenergic vasopressors in adult patients receiving vasopressor therapy for vasodilatory shock or perioperative vasoplegia.
methodsWe searched PubMed, Embase, and Cochrane Library for RCTs comparing non-adrenergic vasopressors with adrenergic vasopressors alone or placebo in critically ill or perioperative patients. Each eligible study was categorized into septic shock, cardiac surgery, or non-cardiac surgery. Non-adrenergic vasopressors included vasopressin, terlipressin, selepressin, angiotensin II, methylene blue, and hydroxocobalamin. The primary outcome was mortality at longest follow-up. We conducted a random-effects meta-analysis. We registered the protocol in PROSPERO International Prospective Register of Systematic Reviews (CRD42024505039).
resultsAmong 51 eligible RCTs totaling 5715 patients, the predominant population was septic shock in 30 studies, cardiac surgery in 11 studies, and non-cardiac surgery in 10 studies. Cochrane risk-of-bias tool for randomized trials version 2 identified 17 studies as low risk of bias. In septic shock, mortality was significantly lower in the non-adrenergic group (960/2232 [43%] vs. 898/1890 [48%]; risk ratio [RR], 0.92; 95% confidence interval [95% CI], 0.86-0.97; P = 0.03; I
conclusionsAdministration of non-adrenergic vasopressors was significantly associated with reduced mortality in patients with septic shock. However, no single agent achieved statistical significance in separate analyses. Although the pooled effects of non-adrenergic vasopressors on survival did not reach statistical significance in patients undergoing cardiac or non-cardiac surgery, the confidence intervals included the possibility of both no effect and a clinically important benefit from non-adrenergic agents. These findings justify the conduct of further RCTs comparing non-adrenergic vasopressors to usual care based on noradrenaline alone.
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