Vasopressin in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials.
J Cardiothorac Vasc Anesth
; 32(5): 2225-2232, 2018 10.
Article
em En
| MEDLINE
| ID: mdl-29748077
ABSTRACT
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 MAINRESULTS:
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
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Pressão Sanguínea
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Vasopressinas
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Ensaios Clínicos Controlados Aleatórios como Assunto
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Procedimentos Cirúrgicos Cardíacos
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Hipotensão
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article