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Vasopressin for the treatment of vasodilatory shock: an ESICM systematic review and a meta-analysis

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  • 2,
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Critical Care201115 (Suppl 1) :P92

  • Published:


  • Public Health
  • Placebo
  • Systematic Review
  • Primary Outcome
  • Norepinephrine


We examine benefits and risks of vasopressin/terlipressin use in patients with vasodilatory shock on mortality and morbidity.


We searched the CENTRAL, MEDLINE, Embase, and LILACS (through to August 2010) databases. Randomized and quasi-randomized trials of vasopressin/terlipressin versus placebo or supportive treatment in adult and pediatric patients with vasodilatory shock were included. The primary outcome for this review was short-term all-cause mortality.


We computed data from 10 randomized trials (n = 1,111). The overall (28-day, 30-day, ICU, hospital and 24-hour) mortality for those treated with vasopressin and terlipressin versus control patients was 237 of 582 (40.7%) versus 226 of 528 (42.8%) (RR, 0.92; 95% CI, 0.81 to 1.04; P = 0.19; I2 = 0%) without increasing the risk of AEs (nine trials 59/585, 10.0% vs. 55/529, 10.3%) (RR, 1.81; 95% CI, 0.62 to 1.86; P = 0.78; I2 = 0%). See Figure 1. Patients receiving vasopressin/terlipressin are associated with a lower dosage of norepinephrine (seven trials, -0.79 μg/kg/minute (95% CI, -1.25 to -0.33; P < 0.001; I2 = 73.6%) and a trend towards a higher urine output within 24 hours of treatment (six trials, 0.40 ml/kg/hour (95% CI, -0.11 to -0.92; P = 0.12; I2 = 67.7%). See Figure 2.
Figure 1
Figure 1

Overall mortality.

Figure 2
Figure 2

Norepinephrine dosage.


No significant effect of vasopressin/terlipressin therapy on all-cause mortality was demonstrated. Overall, there is no evidence to support the routine use of vasopressin or terlipressin in the management of patients with vasodilatory shock. There was, however, a reduction in the dose of norepinephrine used for those patients receiving vasopressin/terlipressin.

Authors’ Affiliations

Ospedale Pediatrico Bambino Gesu, Roma, Italy
Italian Institute of Technology, Milan, Italy
Hôpital Raymond Poincaré (Assistance Publique-Hôpitaux de Paris), Garches, France


© Polito et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.