Annals of
Intensive Care volume 15,
Article number: 18 (2025)
Published: 27 January 2025
Background
The optimal timing
for initiating vasopressor therapy in patients with septic shock remains
unclear. This study aimed to assess the impact of early versus late vasopressor
initiation on clinical outcomes.
Methods
A systematic review
and meta-analysis were conducted by searching PubMed, Embase, and Cochrane
databases. Studies comparing early and late vasopressor administration in
septic shock patients were included. The primary outcome was short-term
mortality, and subgroup analyses were performed based on different initiation
timings.
Results
Eleven studies with
6,661 patients were included. Different studies define the ‘early
administration’ timeframe variously, ranging from one to seven hours. No
significant difference in short-term mortality was observed between early and
late administration in the combined analysis of 3,757 patients from two RCTs
and three quasi-experimental studies (OR: 0.66, 95% CI: [0.36, 1.19], I²: 82%).
However, lower mortality was found in subgroups with early but not extremely
early initiation (one to three hours, OR: 0.70, 95% CI: [0.60, 0.82], I²: 0%),
and those using septic shock diagnosis as time zero (OR: 0.64, 95% CI: [0.48,
0.85], I²: 39%).
Conclusion
Our findings found
that earlier initiation of vasopressor therapy, particularly within one to
three hours after the diagnosis of septic shock, may be associated with reduced
short-term mortality in certain subgroups. However, due to the heterogeneity in
study definitions and potential confounding factors, these results should be
interpreted cautiously. Further standardized investigations are warranted to
precisely determine the optimal timing for vasopressor initiation to maximize
survival outcomes in patients with septic shock.
No comments:
Post a Comment