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Vasopressors for hypotensive shock

Overview of attention for article published in Cochrane database of systematic reviews, February 2016
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (93rd percentile)
  • Good Attention Score compared to outputs of the same age and source (78th percentile)

Mentioned by

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45 tweeters
facebook
12 Facebook pages
wikipedia
2 Wikipedia pages
googleplus
2 Google+ users

Citations

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59 Dimensions

Readers on

mendeley
217 Mendeley
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Title
Vasopressors for hypotensive shock
Published in
Cochrane database of systematic reviews, February 2016
DOI 10.1002/14651858.cd003709.pub4
Pubmed ID
Authors

Gunnar Gamper, Christof Havel, Jasmin Arrich, Heidrun Losert, Nathan L Pace, Marcus Müllner, Harald Herkner

Abstract

Initial goal-directed resuscitation for hypotensive shock usually includes administration of intravenous fluids, followed by initiation of vasopressors. Despite obvious immediate effects of vasopressors on haemodynamics, their effect on patient-relevant outcomes remains controversial. This review was published originally in 2004 and was updated in 2011 and again in 2016. Our objective was to compare the effect of one vasopressor regimen (vasopressor alone, or in combination) versus another vasopressor regimen on mortality in critically ill participants with shock. We further aimed to investigate effects on other patient-relevant outcomes and to assess the influence of bias on the robustness of our effect estimates. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015 Issue 6), MEDLINE, EMBASE, PASCAL BioMed, CINAHL, BIOSIS and PsycINFO (from inception to June 2015). We performed the original search in November 2003. We also asked experts in the field and searched meta-registries to identify ongoing trials. Randomized controlled trials (RCTs) comparing various vasopressor regimens for hypotensive shock. Two review authors abstracted data independently. They discussed disagreements between them and resolved differences by consulting with a third review author. We used a random-effects model to combine quantitative data. We identified 28 RCTs (3497 participants) with 1773 mortality outcomes. Six different vasopressors, given alone or in combination, were studied in 12 different comparisons.All 28 studies reported mortality outcomes; 12 studies reported length of stay. Investigators reported other morbidity outcomes in a variable and heterogeneous way. No data were available on quality of life nor on anxiety and depression outcomes. We classified 11 studies as having low risk of bias for the primary outcome of mortality; only four studies fulfilled all trial quality criteria.In summary, researchers reported no differences in total mortality in any comparisons of different vasopressors or combinations in any of the pre-defined analyses (evidence quality ranging from high to very low). More arrhythmias were observed in participants treated with dopamine than in those treated with norepinephrine (high-quality evidence). These findings were consistent among the few large studies and among studies with different levels of within-study bias risk. We found no evidence of substantial differences in total mortality between several vasopressors. Dopamine increases the risk of arrhythmia compared with norepinephrine and might increase mortality. Otherwise, evidence of any other differences between any of the six vasopressors examined is insufficient. We identified low risk of bias and high-quality evidence for the comparison of norepinephrine versus dopamine and moderate to very low-quality evidence for all other comparisons, mainly because single comparisons occasionally were based on only a few participants. Increasing evidence indicates that the treatment goals most often employed are of limited clinical value. Our findings suggest that major changes in clinical practice are not needed, but that selection of vasopressors could be better individualised and could be based on clinical variables reflecting hypoperfusion.

Twitter Demographics

The data shown below were collected from the profiles of 45 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 217 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 3 1%
Chile 2 <1%
Brazil 1 <1%
Netherlands 1 <1%
United Kingdom 1 <1%
Denmark 1 <1%
Spain 1 <1%
Colombia 1 <1%
Unknown 206 95%

Demographic breakdown

Readers by professional status Count As %
Student > Master 40 18%
Researcher 27 12%
Student > Bachelor 26 12%
Student > Postgraduate 22 10%
Other 21 10%
Other 49 23%
Unknown 32 15%
Readers by discipline Count As %
Medicine and Dentistry 127 59%
Nursing and Health Professions 21 10%
Psychology 9 4%
Pharmacology, Toxicology and Pharmaceutical Science 8 4%
Social Sciences 5 2%
Other 11 5%
Unknown 36 17%

Attention Score in Context

This research output has an Altmetric Attention Score of 32. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 16 April 2020.
All research outputs
#618,280
of 15,051,638 outputs
Outputs from Cochrane database of systematic reviews
#1,751
of 11,088 outputs
Outputs of similar age
#16,506
of 270,655 outputs
Outputs of similar age from Cochrane database of systematic reviews
#41
of 188 outputs
Altmetric has tracked 15,051,638 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 95th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 11,088 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 22.7. This one has done well, scoring higher than 84% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 270,655 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 93% of its contemporaries.
We're also able to compare this research output to 188 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 78% of its contemporaries.