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. 2021 Jul 18;10(14):3164.
doi: 10.3390/jcm10143164.

Vasopressor-Sparing Strategies in Patients with Shock: A Scoping-Review and an Evidence-Based Strategy Proposition

Pierre-Grégoire Guinot  1   2 , Audrey Martin  1 , Vivien Berthoud  1 , Pierre Voizeux  1 , Loic Bartamian  1 , Erminio Santangelo  1 , Belaid Bouhemad  1   2 , Maxime Nguyen  1   2
Affiliations

Vasopressor-Sparing Strategies in Patients with Shock: A Scoping-Review and an Evidence-Based Strategy Proposition

Pierre-Grégoire Guinot et al. J Clin Med. .

Abstract

Despite the abundant literature on vasopressor therapy, few studies have focused on vasopressor-sparing strategies in patients with shock. We performed a scoping-review of the published studies evaluating vasopressor-sparing strategies by analyzing the results from randomized controlled trials conducted in patients with shock, with a focus on vasopressor doses and/or duration reduction. We analyzed 143 studies, mainly performed in septic shock. Our analysis demonstrated that several pharmacological and non-pharmacological strategies are associated with a decrease in the duration of vasopressor therapy. These strategies are as follows: implementing a weaning strategy, vasopressin use, systemic glucocorticoid administration, beta-blockers, and normothermia. On the contrary, early goal directed therapies, including fluid therapy, oral vasopressors, vitamin C, and renal replacement therapy, are not associated with an increase in vasopressor-free days. Based on these results, we proposed an evidence-based vasopressor management strategy.

Keywords: norepinephrine; sepsis; shock; vasopressor; weaning.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart study.
Figure 2
Figure 2
Principles of vasopressor treatment. MAP—mean arterial pressure; ScVO2—central venous oxygen saturation; pCO2 Gap—difference between partial pressure of CO2 in venous blood and arterial blood; SVV—stroke volume variation; PPV—pulse pressure variation.
Figure 3
Figure 3
Algorithm proposed for vasopressor weaning. (A) Basic algorithm. (B) Advanced algorithm based on dynamic arterial elastance analysis. (C) Advanced algorithm based on ventriculo-arterial coupling analysis. EAdyn—dynamic arterial elastance; PPV—pulse pressure variation; SVV—stroke volume variation; Ev—ventricular elastance; EA—arterial elastance.
Figure 3
Figure 3
Algorithm proposed for vasopressor weaning. (A) Basic algorithm. (B) Advanced algorithm based on dynamic arterial elastance analysis. (C) Advanced algorithm based on ventriculo-arterial coupling analysis. EAdyn—dynamic arterial elastance; PPV—pulse pressure variation; SVV—stroke volume variation; Ev—ventricular elastance; EA—arterial elastance.
See this image and copyright information in PMC

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