Background
Methods
Data sources and searches
Study selection and data extraction
Selection criteria
Quality assessment and risk of bias
Data synthesis
Trial sequential analysis
Results
Trial flow
Characteristics and quality of clinical studies included in the meta-analysis
Author, year | Study design | Type of shock/indication for AVP/TP administration | Age | Number of subjects by treatment received | Treatment (medication, dose, duration) | Outcomes | Adverse events | Study period | Oxford levels of evidence 2011 |
---|---|---|---|---|---|---|---|---|---|
Choong et al., 2009 [29] | Randomized controlled double-blind trial (RCT) | Vasodilatory | 1 month to 17 years | 69 children: 35, AVP; 34, placebo | IV AVP continuous infusion: 0.0005–0.002 units/kg/min | Mortality: AVP, 10/33; placebo, 5/32; p = 0.21 MAP: AVP, increase; placebo, increase; p = 0.02 HR: NA UO: AVP, decrease; placebo, decrease; p = 0.65 Catecholamine requirement: AVP, unchanged; placebo, unchanged; p = 0.93 Vasoactive score: AVP,: unchanged; control, unchanged; p = 0.93 | New onset tachycardia: 0 Tissue ischemia/skin lesions: AVP, 2; placebo, 0; p = 0.15 Cardiac arrest: AVP, 1; placebo, 0; p = 0.55 Rhabdomyolysis: 0 Metabolic acidosis: 0 | 4 years | 1b |
Rios and Kaiser, 2015 [27] | Randomized controlled double-blind trial (RCT) | Refractory hypotension | <24 h (mean age: 6.5 h) | 70 ELBW infants: 10, AVP; 10, dopamine; 50, control | IV AVP continuous infusion: 0.0001–0.0006 units/kg/min | Mortality: AVP, 1/10; dopamine, 1/10; control, 0/50; p = 0.261 MAP: AVP, increase (9/10); dopamine, increase (8/10); control, NA; p = 1.0 HR: AVP, unchanged; dopamine, increase; control, NA; p < 0.01 UO: AVP, unchanged; dopamine, unchanged; control, unchanged; p = 0.384 Catecholamine requirement: AVP, unchanged; placebo, unchanged; p = 0.93 Vasoactive score: NA | New onset tachycardia: 0 Tissue ischemia/skin lesions: AVP, 0: dopamine, 1; control, 2; p = 0.15 Cardiac arrest: AVP, 1; placebo, 0; p = 0.801 Rhabdomyolysis: NA Metabolic acidosis: NA | 2 years | 1b |
Yildizdas et al., 2008 [28] | Clinical, non-blind, controlled trial, | Septic | 1 month to 5.5 years | 58 children: 30, TP; 28, control | IV TP bolus: 20 μg/kg every 6 h | Mortality: TP, 20/30; control, 20/28; p = 0.1 MAP: TP, increase; p = 0.001; control, NA HR: TP, decrease, p = 0.001, control, NA UO: TP, unchanged;, control, unchanged; p = 0.2 Catecholamine requirement: NA Vasoactive score: NA | New onset tachycardia: 0 Tissue ischemia/skin lesions: TP, 5; control, 3; p = 0.3 Cardiac arrest: 0 Rhabdomyolysis: 0 Metabolic acidosis: 0 | 6 months | 1b |
Agrawal et al., 2012 [30] | Clinical trial | Vasodilatory (post-cardiac surgery) | 1 month to 8.5 years | 12 children | IV AVP continuous infusion: 0.0005–0.03 units/kg/min | Mortality: 3/12 Morbidity: NA MAP: increase; p < 0.001 HR: unchanged; p = 0.188 UO: NA Catecholamine requirement: decrease; p < 0.001 Vasoactive score: after AVP, decrease; p = 0.001 | New onset tachycardia: 0 Tissue ischemia/skin lesions: 0 Cardiac arrest: 0 Rhabdomyolysis: 0 Metabolic acidosis: 0 | 6 months | 1c |
Rodriguez-Núñez et al., 2010 [31] | Clinical trial | Septic | 24 days to 15 years | 15 children | IV TP loading dose: 20 μg/kg continuous infusion: 4–20 μg/kg/h | Mortality: 7/15 Morbidity: NA MAP: increase; p < 0.05 HR: decrease; p < 0.05 UO: NA Catecholamine requirement: decrease, p < 0.05 | New onset tachycardia: 0 Tissue ischemia/skin lesions: 4 Cardiac arrest: 1 Rhabdomyolysis: 4 Metabolic acidosis: 3 | 32 months | 1c |
Rodriguez-Núñez et al., 2006 [32] | Clinical trial | Septic | 1 month to 13 years | 16 children | IV TP bolus: 0.02 mg/kg every 4 h, for a maximum of 17 h | Mortality: 9/16 Morbidity: NA MAP: increase; p < 0.01 HR: unchanged; p = not significant UO: NA Catecholamine requirement: decrease; p < 0.05 Vasoactive score: after AVP, decrease; p < 0.05 | New onset tachycardia: 0 Tissue ischemia/skin lesions: 5 Cardiac arrest: 0 Rhabdomyolysis: 2 Metabolic acidosis: 0 | 12 months | 1c |
Bidegain et al., 2010 [34] | Observational-retrospective | Refractory hypotension/septic | 1 day to 8 months | 20 children | IV AVP continuous infusion: 0.00017–0.0007 units/kg/min | Mortality: 13/20 Morbidity: NA MAP: increase; p = 0.002 HR: decrease; p = 0.45 UO: decrease; p = 0.36 Catecholamine requirement: decrease; dopamine, p = 0.006; epinephrine, p = 0.04 | New onset tachycardia: 0 Tissue ischemia/skin lesions: 0 Cardiac arrest: 0 Rhabdomyolysis: 0 Metabolic acidosis: 0 | 2.5 years | 1c |
Matok et al., 2005 [33] | Observational-retrospective | Septic | 4 days to 17.7 years | 14 children | IV TP: loading dose: 7 μg/kg/dose, twice daily maintenance: 20 μg/kg every 6 h | Mortality: 8/14 Morbidity: NA MAP: increase; p = 0.001 HR: decrease; p = 0.003 UO: increase, p = 0.011 Catecholamine requirement: decrease, 8/14; p = NA | New onset tachycardia: 0 Tissue ischemia/skin lesions: 0 Cardiac arrest: 0 Rhabdomyolysis: 0 Metabolic acidosis: 0 | 1 year | 1c |