Effect of norepinephrine versus vasopressin weaning on incidence of hypotension in septic shock patients: a systematic review and meta-analysis.

OBJECTIVE

To evaluate the influence of weaning vasopressors - norepinephrine or vasopressin - on deleterious effects; the main objective was to evaluate the incidence of hypotension.

METHODS

We performed a systematic review and meta-analysis of 11 studies - 2 randomized controlled trials and 9 observational studies - involving 2,280 patients in whom norepinephrine (n = 1,254) or vasopressin (n = 1,026) was withdrawn first to compare the risk of hypotension and other adverse effects.

RESULTS

Hypotension occurred in 33.4% (420/1,254) of patients in the Norepinephrine Group and in 52,4% (538/1,026) of patients in the Vasopressin Group. There was no difference between groups regarding the incidence of hypotension: OR 0.43 (95%CI 0.18 - 1.03). The subgroup analysis of observational studies suggests a lower incidence of hypotension when norepinephrine is weaned first (OR 0.26; 95%CI 0.13 - 0.53), with high heterogeneity between studies (I2 = 88%; p < 0.01). On the other hand, the subgroup of randomized controlled trials indicates a higher incidence of hypotension when norepinephrine is weaned first (OR 4.04; 95%CI 1.24 - 13.15; I2 = 65%, p = 0.09). The weaning strategy was not associated with other outcomes, including intensive care unit length of stay, hospital length of stay, time on vasopressors, arrhythmias, renal injury, or SOFA.

CONCLUSION

No differences in hypotension incidence were observed when weaning was initiated with either norepinephrine or vasopressin. However, the high heterogeneity observed across studies warrants caution in drawing definitive conclusions.