Vasoactive agents in acute mesenteric ischaemia in critical care. A systematic review

Christopher A. Brennan*, Peter Osei-Bonsu, Rachael Eimear McClenaghan, Ahmed Nassar, Patrice Forget, Callum Kaye, George Ramsay

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

Background: Acute mesenteric ischaemia (AMI) is a surgical emergency which has an associated high mortality. The mainstay of active treatment includes early surgical intervention, with resection of non-viable bowel, and revascularisation of the ischaemic bowel where possible. Due to the physiological insult of AMI however, perioperative care often involves critical care and the use of vasoactive agents to optimise end organ perfusion. A number of these vasoactive agents are currently available with varied mechanism of action and effects on splanchnic blood flow. However, specific guidance on which is the optimal vasoactive drug to use in these settings is limited. This systematic review aimed to evaluate the current evidence comparing vasoactive drugs in AMI. Methods: A systematic search of Ovid Medline, Ovid Embase, Cochrane CENTRAL and the Cochrane Database of Systematic Review was performed on the 5th of November 2020 to identify randomised clinical trials comparing different vasoactive agents in AMI on outcomes including mortality. The search was performed through the Royal College of Surgeons of England (RCSEng) search support library. Results were analysed using the Rayyan platform, and independently screened by four investigators. Results: 614 distinct papers were identified. After screening, there were no randomised clinical trials meeting the inclusion criteria. Conclusions: This review identifies a gap in literature, and therefore recommends an investigation into current practice and clinician preference in relation to vasoactive agents in AMI. Multicentre randomised controlled trials comparing these medications on clinical outcomes will therefore be required to address this question.

Original languageEnglish
Article number453
Number of pages21
JournalF1000Research
Volume10
Early online date8 Jun 2021
DOIs
Publication statusPublished - 6 Sep 2021

Keywords

  • Aberdeen
  • Acute Mesenteric Ischaemia
  • AMI
  • CDSR
  • COCHRANE
  • Critical Care
  • DELPHI
  • Dobutamine
  • Dopamine
  • Dopexamine
  • EMBASE
  • General Surgery
  • Grampian
  • Human
  • Infarction
  • Ischaemic
  • Levosimendan
  • MEDLINE
  • Milronone
  • Noradrenaline
  • OVID
  • Perioperative care
  • Splanchnic blood flow
  • Systematic review
  • Vasoactives
  • Vasopressors

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