Objectives: Epinephrine is frequently used as an inotropic and vasopressor agent in critically ill patients requiring hemodynamic support. Data from observational trials suggested that epinephrine use is associated with a worse outcome as compared with other adrenergic and nonadrenergic vasoactive drugs. We performed a systematic review and meta-analysis of randomized controlled trials to investigate the effect of epinephrine administration on outcome of critically ill patients.
Data Sources: PubMed, EMBASE, and Cochrane central register were searched by two independent investigators up to March 2019.
Study Selection: Inclusion criteria were: administration of epinephrine as IV continuous infusion, patients admitted to an ICU or undergoing major surgery, and randomized controlled trials. Studies on epinephrine administration as bolus (e.g., during cardiopulmonary resuscitation), were excluded. The primary outcome was mortality at the longest follow-up available.
Data Extraction: Two independent investigators examined and extracted data from eligible trials.
Data Synthesis: A total of 5,249 studies were assessed, with a total of 12 studies (1,227 patients) finally included in the meta-analysis. The majority of the trials were performed in the setting of septic shock, and the most frequent comparator was a combination of norepinephrine plus dobutamine. We found no difference in all-cause mortality at the longest follow-up available (197/579 [34.0%] in the epinephrine group vs 219/648 [33.8%] in the control group; risk ratio = 0.95; 95% CI, 0.82-1.10; p = 0.49; I = 0%). No differences in the need for renal replacement therapy, occurrence rate of myocardial ischemia, occurrence rate of arrhythmias, and length of ICU stay were observed.
Conclusions: Current randomized evidence showed that continuous IV administration of epinephrine as inotropic/vasopressor agent is not associated with a worse outcome in critically ill patients.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/CCM.0000000000004127 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Transforming medical anthropology: Community, praxis, and the Black Feminist Health Science Studies Collaboratory.
Med Anthropol Q
January 2025
Department of African American Studies, University of California, Los Angeles, California, USA.
Despite the transformative contributions of Black feminist thought, medical anthropology often fails to recognize or center the works of Black feminist thinkers. We argue that Black feminist theory is critical for a study and praxis of new approaches to healing, health, medicine, illness, disability, and care. We can't continue to simply recognize that current systems are failing us; Black feminist theory moves us past recognition toward transformative liberation.
View Article and Find Full Text PDFDo Danish ICU Survivors Remain Employed After ICU Discharge? A Register-Based Longitudinal Cohort Study.
Crit Care Med
November 2024
Department of Public Health Epidemiology, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Objectives: Admission to ICU is associated with long-term consequences for the survivors. The study explores whether Danish ICU survivors remain employed after ICU discharge.
Design: A longitudinal register study of 16,284 Danish ICU survivors 25-67 years old 1:1 sex- and age-matched with general population references.
The Evolving Case for Skin Failure-Beyond Pressure Injury.
JAMA Intern Med
January 2025
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Association Between the Ultrasound Evaluation of Muscle Mass and Adverse Outcomes in Critically Ill Patients: A Prospective Cohort Study.
Anesth Analg
February 2025
SC Terapia Intensiva Neurochirurgica, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milano, Italy.
Background: Computed tomography (CT)-derived low muscle mass is associated with adverse outcomes in critically ill patients. Muscle ultrasound is a promising strategy for quantitating muscle mass. We evaluated the association between baseline ultrasound rectus femoris cross-sectional area (RF-CSA) and intensive care unit (ICU) mortality.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!