PMID- 31645176
OWN - NLM
STAT- MEDLINE
DCOM- 20200529
LR  - 20220411
IS  - 1525-1489 (Electronic)
IS  - 0885-0666 (Linking)
VI  - 35
IP  - 2
DP  - 2020 Feb
TI  - Nonocclusive Mesenteric Ischemia and Interventional Local Vasodilatory Therapy: A 
      Meta-Analysis and Systematic Review of the Literature.
PG  - 128-139
LID - 10.1177/0885066619879884 [doi]
AB  - BACKGROUND: Intensive care patients with nonocclusive mesenteric ischemia (NOMI) 
      show mortality rates of 70% to 90%. Besides emergency surgery, different 
      interventional local vasodilatory treatment (LVT) attempts have been described. 
      We performed a systematic review and a meta-analysis to evaluate feasibility, 
      efficacy, and tolerability of LVT in patients with life-threatening NOMI. 
      METHODS: Searches of PubMed, EMBASE, Web of Science, and Cochrane Library 
      databases were performed until February 2019. Measured outcomes included 
      immediate technical success rates (as indicated by mesenteric vasodilation on 
      angiography or clinical improvement) and adverse events (AEs). Therapeutic 
      efficacy was measured by the assessment of overall mortality. RESULTS: Twelve 
      studies (335 patients, 245 received LVT) from 1977 to 2018 were included. All 
      studies were retrospective (4 comparative and 8 noncomparative). Different 
      intra-arterial vasodilators (4x papaverine, 6x prostaglandin E1, 1x 
      tolazoline/heparin, 1x tolazoline + iloprost) were reported. Initial technical 
      success rate was 75.9% (95% confidence interval [CI], 55.1%-89%, P = .017) with 
      an AE rate of 2.9% (95% CI: 1.3%-6.6%; P = .983). Overall mortality in LVT 
      patients was 40.3% (95% CI: 28.7%-53%, P = .134). In 4 studies, outcomes were 
      compared between patients receiving LVT to those who received standard of care 
      (odds ratio for death in LVT patients was 0.261 [95% CI: 0.095-0.712, P = .009]). 
      CONCLUSIONS: Local vasodilatory treatment appears to be safe in patients with 
      NOMI and might have the potential to at least partially reverse mesenteric 
      vasoconstriction features in control angiographies. However, with no randomized 
      and prospective studies available yet, the overall quality of published studies 
      has to be considered as low; therefore, it is not possible to draw generalizable 
      conclusions from the present data concerning clinical end points. Its application 
      might hold promise as a rescue treatment strategy and deserves further evaluation 
      in randomized controlled trials.
FAU - Stahl, Klaus
AU  - Stahl K
AUID- ORCID: 0000-0002-4833-6035
AD  - Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical 
      School, Hannover, Germany.
FAU - Rittgerodt, Nina
AU  - Rittgerodt N
AD  - Department of Nephrology and Hypertension, Hannover Medical School, Hannover, 
      Germany.
FAU - Busch, Markus
AU  - Busch M
AD  - Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical 
      School, Hannover, Germany.
FAU - Maschke, Sabine K
AU  - Maschke SK
AD  - Department of Diagnostic und Interventional Radiology, German Centre of Lung 
      Research (DZL), Hannover, Germany.
FAU - Schneider, Andrea
AU  - Schneider A
AD  - Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical 
      School, Hannover, Germany.
FAU - Manns, Michael P
AU  - Manns MP
AD  - Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical 
      School, Hannover, Germany.
FAU - Fuge, Jan
AU  - Fuge J
AD  - Department of Respiratory Medicine and German Centre of Lung Research (DZL), 
      Hannover Medical School, Hannover, Germany.
FAU - Meyer, Bernhard C
AU  - Meyer BC
AD  - Department of Nephrology and Hypertension, Hannover Medical School, Hannover, 
      Germany.
FAU - Hoeper, Marius M
AU  - Hoeper MM
AD  - Department of Respiratory Medicine and German Centre of Lung Research (DZL), 
      Hannover Medical School, Hannover, Germany.
FAU - Hinrichs, Jan B
AU  - Hinrichs JB
AD  - Department of Diagnostic und Interventional Radiology, German Centre of Lung 
      Research (DZL), Hannover, Germany.
FAU - David, Sascha
AU  - David S
AUID- ORCID: 0000-0002-8231-0461
AD  - Department of Nephrology and Hypertension, Hannover Medical School, Hannover, 
      Germany.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20191023
PL  - United States
TA  - J Intensive Care Med
JT  - Journal of intensive care medicine
JID - 8610344
RN  - 0 (Vasodilator Agents)
SB  - IM
MH  - Critical Care/*methods
MH  - Humans
MH  - Intensive Care Units
MH  - Mesenteric Ischemia/*drug therapy/*mortality
MH  - Odds Ratio
MH  - Retrospective Studies
MH  - Standard of Care
MH  - Treatment Outcome
MH  - Vasodilation
MH  - Vasodilator Agents/*therapeutic use
OTO - NOTNLM
OT  - local vasodilatory treatment
OT  - nonocclusive mesenteric ischemia
OT  - sepsis
OT  - shock
EDAT- 2019/10/28 06:00
MHDA- 2020/05/30 06:00
CRDT- 2019/10/25 06:00
PHST- 2019/10/28 06:00 [pubmed]
PHST- 2020/05/30 06:00 [medline]
PHST- 2019/10/25 06:00 [entrez]
AID - 10.1177/0885066619879884 [doi]
PST - ppublish
SO  - J Intensive Care Med. 2020 Feb;35(2):128-139. doi: 10.1177/0885066619879884. Epub 
      2019 Oct 23.