Open Access Review

Does vasopressor therapy have an indication in hemorrhagic shock?

François Beloncle12, Ferhat Meziani34, Nicolas Lerolle12, Peter Radermacher5 and Pierre Asfar12*

Author Affiliations

1 Laboratoire HIFIH, UPRES EA 3859, IFR 132, Université d’Angers, PRES LUNAM, Angers, France

2 Département de réanimation médicale et de médecine hyperbare, CHU d’Angers, 4 rue Larrey, Cedex 9, F-49933, Angers, France

3 Laboratoire de Biophotonique et Pharmacologie, UMR 7213 CNRS, Université de Strasbourg, Strasbourg, France

4 Service de réanimation médicale, Nouvel Hôpital Civil, Hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67031, Strasbourg, France

5 Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Klinik für Anästhesiologie, Ulm, Germany

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Annals of Intensive Care 2013, 3:13  doi:10.1186/2110-5820-3-13

Published: 22 May 2013

Abstract

This review aimed to answer whether the vasopressors are useful at the early phase of hemorrhagic shock. Data were taken from published experimental studies and clinical trials. Published case reports were discarded. A search of electronic database PubMed was conducted using keywords of hemorrhagic shock, vasopressors, vasoconstrictors, norepinephrine, epinephrine, vasopressin. The redundant papers were not included. We identified 15 experimental studies that compared hemorrhagic shock resuscitated with or without vasopressors, three retrospective clinical studies, and one controlled trial. The experimental and clinical studies are discussed in the clinical context, and their strengths as well as limitations are highlighted. There is a strong rationale for a vasopressor support in severe hemorrhagic shock. However, this should be tempered by the risk of excessive vasoconstriction during such hypovolemic state. The experimental models must be analyzed within their own limits and cannot be directly translated into clinical practice. In addition, because of many biases, the results of clinical trials are debatable. Therefore, based on current information, further clinical trials comparing early vasopressor support plus fluid resuscitation versus fluid resuscitation alone are warranted.

Keywords:
Hemorrhage; Shock; Trauma; Critical care; Vasopressors; Experimental studies; Clinical studies