• Gary Duclos, Karine Baumstarck, Martin Dünser, Laurent Zieleskiewicz, and Marc Leone.
• Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, 13015 Marseille, France. Electronic address: Gary.duclos@ap-hm.fr.
• Heart Lung. 2019 Nov 1; 48 (6): 560-565.

BackgroundAlthough the order of vasopressor initiation in patients with septic shock is established, limited information is available on the order of vasopressor discontinuation.MethodsWe performed a meta-analysis of nine studies involving 1245 patients in whom norepinephrine (n = 787) or vasopressin (n = 458) was withdrawn first to compare the risk of hypotension.ResultsThe risk of hypotension increased in patients whom vasopressin was withdrawn first (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.3-8.9; p = 0.01). A sensitivity analysis indicated that this effect was observed in four studies with a high risk of bias (OR, 5.4; 95%CI, 1.3-23.5; p = 0.02) and was not observed in five studies with a low risk of bias (OR, 2.4; 95%CI, 0.6-8.4; p = 0.18).ConclusionOur results suggest that the risk of hypotension is higher in patients with septic shock in whom vasopressin is withdrawn before norepinephrine.Copyright © 2019 Elsevier Inc. All rights reserved.

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