Benefit of inodilators in septic shock patients: A systematic review and network meta-analysis
Inodilators in septic shock: Network meta-analysis
DOI:
https://doi.org/10.54205/ccc.v33.269549คำสำคัญ:
Inodilator, Septic shock, Milrinone, Dobutamine, Levosimendanบทคัดย่อ
Background: The efficacy of inodilator agents, including dobutamine, levosimendan, and milrinone, in patients with septic cardiomyopathy on mortality outcomes is still a controversial issue. This systematic review and network meta-analysis aimed to assess the impact of inodilator agents on mortality outcomes and hemodynamic data when utilizing these inodilators compared to placebo.
Method: We conducted a network meta-analysis and searched PubMed, Embase, Cochrane Library, Scopus, and ClinicalTrials.gov for randomized controlled trials and prospective cohort studies examining the use of levosimendan, dobutamine, or milrinone in patients with septic shock. The primary outcomes were short-term mortality. The secondary outcome were ICU length of stay, and hemodynamic parameters.
Results: Fourteen studies involving 1164 participants were included in the analysis. In terms of short-term mortality, levosimendan ranked the highest with a relative risk (RR) of 0.93 (95% CI 0.77-1.13) compared to placebo. The second and third rankings were milrinone (RR of 0.91; 95% CI 0.65-1.27) and dobutamine (RR of 1.12; 95% CI 0.84-1.51), respectively. Regarding ICU length of stay, Levosimendan ranked the first with a mean difference (MD) of -0.83 (95% CI -2.58 to 0.93), while dobutamine, ranking second, demonstrated a MD of 0.30 (95% CI -2.45 to 3.05) compared to placebo. In terms of heart rate, levosimendan was the first ranking with a MD of 0.25 (95% CI -4.57 to 5.07) compared to placebo, followed by milrinone with a MD of 0.00 (95% CI -10.14 to 10.14), and dobutamine with a MD of 1.43 (95% CI -4.59 to 7.45). All results had very low certainty of evidence.
Conclusions: There were no statistically significant differences in short-term mortality, length of ICU stays, and tachyarrhythmia among septic shock patients treated with inodilator agents. The application of these agents in clinical practice should be tailored to individual patient characteristics. Further randomized controlled trials with larger sample sizes are necessary to establish more definitive evidence.
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