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Dopamine versus dobutamine for hypotensive preterm infants

Dopamine improves low blood pressure (hypotension) in preterm babies more effectively than dobutamine in the short‐term, but evidence on safety and long‐term effectiveness is needed. Hypotension may cause brain injury and other serious problems for preterm babies (born before 37 weeks). Treatment aims to maintain blood flow to the brain and other organs, by using fluids or drugs to increase blood pressure. Inotrope drugs, including dopamine and dobutamine, are commonly used to increase blood pressure. However, the safest and most effective drug for treating hypotension in preterm babies has been unclear. The review found that dopamine was more effective than dobutamine for short‐term treatment, but the effects of these drugs on long‐term outcomes is unknown. More trials are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Comparison of low-dose dobutamine stress echocardiography and single photon emission computed tomography and delayed contrast MRI in the diagnosis of myocardial viability: Meta-analysis

Bibliographic details: Li WL, Chen X, Guo XJ, Liu M, Yan R, Guo YM.  Comparison of low-dose dobutamine stress echocardiography and single photon emission computed tomography and delayed contrast MRI in the diagnosis of myocardial viability: Meta-analysis. Chinese Journal of Radiology 2009; 43(9): 942-947

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Methodological analysis of diagnostic dobutamine stress echocardiography studies

BACKGROUND: Dobutamine stress echocardiography (DSE) is an accepted test for the diagnosis of coronary artery disease (CAD), despite its wide diagnostic accuracy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

The effect of inotropes on morbidity and mortality in preterm infants with low systemic or organ blood flow

Low systemic blood flow is common in extremely premature infants and has been associated with brain and intestinal injury, death and developmental impairment. It is unclear what is the best strategy to prevent or treat this. The usual strategy for supporting the cardiovascular system of the preterm infant is to treat infants with low blood pressure with agents (inotropes) aimed at increasing blood pressure. However, many of infants with low blood flow have normal blood pressure. One trial was found that examined the effect of inotropes in infants with low systemic blood flow. The trial found that many infants failed to respond to the two commonly used inotropes (dobutamine and dopamine) and neither was better at improving outcomes of very preterm babies. Further research is needed to determine the best strategy for preventing or treating low systemic or organ blood flow in these very immature babies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Levosimendan versus dobutamine in critically ill patients: a meta-analysis of randomized controlled trials

OBJECTIVE: To evaluate the clinical efficacy of levosimendan versus dobutamine in critically ill patients requiring inotropic support.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Dobutamine stress echocardiography in patients undergoing orthotopic liver transplantation: a pooled analysis of accuracy, perioperative and long term cardiovascular prognosis

Pre-transplant evaluation for orthotopic liver transplantation (OLT) commonly includes a cardiac evaluation using dobutamine stress echocardiography (DSE). We performed a quantitative systematic review assessing DSE's use in detecting coronary artery disease (CAD) and predicting perioperative and long term cardiac events in patients undergoing OLT. Published studies in pubmed were accessed using keyword searches and bibliographic review. Included studies evaluated the use of DSE in patients undergoing OLT, including its accuracy for detection of CAD, and in predicting perioperative and long term cardiac prognosis for both hard (myocardial infarction, cardiac death, cardiac arrest, and asystole) and soft cardiac events (all other events that were cardiovascular in nature). We calculated DSE's sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) in the above areas. We identified 7 studies, including a total of 580 patients, which included 4 accuracy studies (n = 110 patients), 4 perioperative studies, and 3 long term studies. Accuracy for CAD included a sensitivity of 0.32, specificity of 0.78, PPV of 0.37, and NPV of 0.75. Accuracy for prediction of perioperative hard and soft cardiac events was a sensitivity of 0.20 and 0, specificity of 0.99 and 0.99, PPV of 0.33 and 0, and NPV of 0.98 and 0.89, respectively. For long term hard and soft cardiac events, sensitivity was 0.5 and 0, specificity 0.99 and 0.98, PPV 0.33 and 0, and NPV 0.99 and 0.96, respectively. DSE has a limited accuracy for the detection of CAD in candidates for OLT. However, among those patients selected for OLT, the negative predictive value of DSE for both perioperative and long term cardiac events is high.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Dobutamine for patients with severe heart failure: a systematic review and meta-analysis of randomised controlled trials

This review concluded that, compared to placebo or standard care, dobutamine was not associated with improved mortality in patients with heart failure. There was a suggestion (although not statistically significant) of increased mortality. Poor methodological reporting in included studies limited conclusions. Data came from generally small studies of questionable quality and the authors conservative conclusions reflect this.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

The diagnostic role of stress echocardiography in women with coronary artery disease: evidence based review

This review compared the performance of stress echocardiography with other noninvasive imaging techniques for the diagnosis of coronary artery disease in women with chest pain. The searches were restricted and the reporting of methodology limited. The author's conclusion, that the limited data indicate that dobutamine stress echocardiography has higher specificities and similar sensitivities to other tests, is reasonable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review

The authors described the effect of direct haemoperfusion with polymixin B-immobilized fiber column (PMX-F) on clinical outcomes in patients with sepsis. The authors concluded that treatment appeared to have beneficial effects on blood pressure, use of vasoactive drugs, oxygenation and mortality. Limitations of the included studies and the review methodology mean that the results may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women [Internet]

To conduct a systematic review of the medical literature assessing (1) accuracy of noninvasive technologies (NITs) for diagnosing coronary artery disease (CAD) in women with symptoms suspicious for CAD, (2) predictors affecting test accuracy, (3) ability of NITs to provide risk stratification, prognostic information, inform decisionmaking about treatment options, and affect clinical outcomes, and (4) risks to women undergoing these tests.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: June 2012
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Stable Angina: Methods, Evidence & Guidance [Internet]

Angina is pain or constricting discomfort that typically occurs in the front of the chest (but may radiate to the neck, shoulders, jaw or arms) and is brought on by physical exertion or emotional stress. It is the main symptomatic manifestation of myocardial ischaemia and is usually caused by obstructive coronary artery disease restricting oxygen delivery to the cardiac myocytes. Other factors may exacerbate angina either by further restricting oxygen delivery (for example severe anaemia) or by increasing oxygen demand (for example left ventricular hypertrophy). Angina symptoms are associated with other cardiac disease such as aortic stenosis but the management of angina associated with non-coronary artery disease is outside the scope of this guideline.

NICE Clinical Guidelines - National Clinical Guidelines Centre (UK).

Version: July 2011
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Milrinone to prevent reduced heart function and death after heart surgery in children

Background: Children who are born with heart defects often undergo heart surgery at a young age. They are at risk for reduced heart function and death after surgery. Milrinone is a medication that may be used in this situation to make the heart stronger and make it easier for the heart to pump blood into the body.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Inotropic and vasodilator strategies in patients with a heart attack (acute myocardial infarction) and cardiogenic shock or low cardiac output

Cardiogenic shock occurring in 5% to 10% of patients with acute myocardial infarction still remains a life‐threatening complication. As regards treatment options with inotropic and vasoactive drugs for infarct related cardiogenic shock, there is only very little evidence generated by randomised controlled trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Adrenaline for prevention of morbidity and mortality in preterm infants with cardiovascular compromise

Not enough evidence from trials on the use of adrenaline (epinephrine) for preterm babies with poor heart rates and circulation. Sustained poor blood flow in preterm babies can lead to complications, including impaired development. Inotrope drugs, particularly dopamine and dobutamine, are commonly used to increase heart rate and blood pressure in preterm babies with poor circulation. Adrenaline (epinephrine) is another inotrope drug that can be used. The review found that there is not enough evidence from trials to show the effects of adrenaline on preterm babies with poor circulation, and more research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Cardiac testing for coronary artery disease in potential kidney transplant recipients

Background: Patients with chronic kidney disease (CKD) are at increased risk of coronary artery disease (CAD) and adverse cardiac events. Screening for CAD is therefore an important part of preoperative evaluation for kidney transplant candidates. There is significant interest in the role of non‐invasive cardiac investigations and their ability to identify patients at high risk of CAD. 

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Optimizing Health System Use of Medical Isotopes and Other Imaging Modalities [Internet]

The purpose of this project was to provide national guidance on the optimal use of 99mTc during a situation of reduced supply. To accomplish this, our objective at CADTH was:

Optimal Use Report - Canadian Agency for Drugs and Technologies in Health.

Version: 2012
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Vasopressors for shock

Circulatory shock is broadly defined as circulatory failure resulting in the body's inability to maintain organ perfusion and to meet oxygen demands. It usually presents with low blood pressure. Up to every third patient with circulatory shock may be admitted to the intensive care unit because of circulatory failure, and mortality in the intensive care unit ranges from 16% to 60%. For treatment, fluid replacement is followed by vasopressor agents, if necessary. A vasopressor agent is an agent that causes a rise in blood pressure. Vasopressor therapy is an important part of haemodynamic support in patients with shock (where haemodynamics is defined as the flow of blood in the circulatory system). A number of different vasopressors are available.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

An Evaluation of the Feasibility, Cost and Value of Information of a Multicentre Randomised Controlled Trial of Intravenous Immunoglobulin for Sepsis (Severe Sepsis and Septic Shock): Incorporating a Systematic Review, Meta-Analysis and Value of Information Analysis

Sepsis is a syndrome characterised by a systemic inflammatory response to infection that leads to rapid acute organ failure and potentially rapid decline to death. Intravenous immunoglobulin (IVIG), a blood product derived from human donor blood, has been proposed as an adjuvant therapy for sepsis.

Health Technology Assessment - NIHR Journals Library.

Version: February 2012
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Chest Pain of Recent Onset: Assessment and Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin [Internet]

Chest pain or discomfort caused by acute coronary syndromes (ACS) or angina has a potentially poor prognosis, emphasising the importance of prompt and accurate diagnosis. Treatments are available to improve symptoms and prolong life, hence the need for this guideline.

NICE Clinical Guidelines - National Clinical Guideline Centre for Acute and Chronic Conditions (UK).

Version: March 2010
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Bacterial Meningitis and Meningococcal Septicaemia: Management of Bacterial Meningitis and Meningococcal Septicaemia in Children and Young People Younger than 16 Years in Primary and Secondary Care

This guideline covers bacterial meningitis and meningococcal septicaemia, focusing on management of these conditions in children and young people aged younger than 16 years in primary and secondary care, and using evidence of direct relevance to these age groups where available.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: 2010
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Systematic Reviews in PubMed

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