Vaptans for the Management of Hyponatremia in Neurocritical Care: a Systematic Review
Tóm tắt
Hyponatremia occurs frequently following acute neurological insults and is associated with adverse outcomes. Vasopressin receptor antagonists—‘vaptans’—are a recognized treatment for hyponatremia in other settings. We aimed to review the efficacy and safety of vaptans in a neurointensive care population. MEDLINE, Embase and Cochrane Library were searched from inception to July 2020. Eligible studies met the following criteria: (a) randomized controlled trials, non-randomized controlled trials, observational studies, case series and case reports; (b) adult patients (aged ≥ 18 years); (c) exposure to an acute neurological insult; (d) exposure to hyponatremia; and (e) outcome measure of sodium homeostasis. Our search retrieved 1,610 citations with 18 articles assessed for inclusion. After full text extraction, 13 studies inclusive of 272 patients met the eligibility criteria. There were four case reports, seven case series and two randomized controlled trials. Eight articles reported on intravenous conivaptan at doses ranging from 10 to 40 mg, four reported on oral tolvaptan at doses ranging from 7.5 to 15 mg and one study compared intravenous conivaptan with oral tolvaptan. All studies reported an increase in plasma sodium between 6 and 24 h after vaptan administration. Adverse events occurred frequently; 18 patients (6.8%) had an excessively rapid correction in plasma sodium, and 59 patients (22%) developed hypotension or a decrease in mean arterial pressure by > 20%. Observational data suggest vaptans effectively raise plasma sodium in the setting of acute neurological insults. However, the utility of vaptans may be limited by their side effect profile.
Tài liệu tham khảo
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