Vasopressin in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

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art_DUENSER_Vasopressin_in_Cardiac_Surgery_A_Metaanalysis_of_Randomized_2018.PDF (1.01 MB)
Citações na Scopus
33
Tipo de produção
article
Data de publicação
2018
Editora
W B SAUNDERS CO-ELSEVIER INC
DOI
Indexadores
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Autores
DUENSER, Martin W.
BOUVET, Olivier
KNOTZER, Hans
ARULKUMARAN, Nish
ULMER, Hanno
HASIBEDER, Walter R.
Autor de Grupo de pesquisa
Editores
Coordenadores
Organizadores
Citação
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, v.32, n.5, p.2225-2232, 2018
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Objective: To summarize the results of randomized controlled trials on the use of vasopressin as a vasopressor agent in cardiac surgery. Design: Meta-analysis. Participants: Six-hundred-twenty-five adult patients undergoing elective or emergency cardiac surgery. Interventions: Arginine vasopressin infusion (n = 313) or control/standard therapy (n = 312). Measurements and Main Results: The rates of perioperative complications and postoperative mortality were used as primary and secondary endpoints, respectively. Fixed and/or random effects models were used to compare pooled odds ratios. Arginine vasopressin reduced the pooled odds ratio (OR) of perioperative complications (OR, 0.33; 95% confidence interval [CI], 0.2-0.54; p < 0.0001). A sensitivity analysis excluding the largest trial showed an unchanged reduction in perioperative complications (OR, 0.35; 95% CI, 0.18-0.69; p = 0.002). When analyzing each perioperative complication separately, vasopressin reduced the pooled OR of vasodilatory shock (OR, 0.4; 95% CI, 0.16-0.97; p = 0.04) and new-onset atrial fibrillation (OR, 0.42; 95% CI, 0.21-0.82; p = 0.01). The pooled OR of postoperative death was not different between patients treated with arginine vasopressin and those receiving standard therapy or placebo (OR, 0.83; 95% CI, 0.45-1.53; p = 0.55). The funnel plot for the primary endpoint suggested a relevant publication bias. All included trials suffered from a high risk of bias. Conclusion: Our meta-analysis suggests that arginine vasopressin may reduce the rate of perioperative complications in patients undergoing elective or emergency cardiac surgery. No difference in postoperative mortality was observed. An adequately powered multicenter trial is required for reliable estimation of the effects of arginine vasopressin on perioperative complication rates and mortality in cardiac surgical patients.
Palavras-chave
Arginine vasopressin, cardiac surgery, mortality, perioperative complications, acute kidney injury, atrial fibrillation, vasodilatory shock
URI
https://observatorio.fm.usp.br/handle/OPI/29416
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/08
Artigos e Materiais de Revistas Científicas - ODS/03