THERAPY OF SHOCK WITH NALOXONE - A METAANALYSIS

Objectives: To evaluate the effectiveness of naloxone in human shock; and to estimate the methodologic quality of the clinical trials. Data Sources: Computerized bibliographic search on MEDLINE covering the per iod from January 1979 to July 1996, review of references of all papers found on the subject, and contact with primary investigators of eligi ble studies. Study Selection: To be included in this study, a paper sh ould be a randomized, clinical trial published in a peer-reviewed jour nal evaluating naloxone in human shock, regardless of the patient's ag e (adult, child, neonate). Three independent readers reviewed 61 human publications and selected five clinical trials. Overall agreement on study selection was perfect (concordance: 100%), We excluded a posteri ori two studies whose authors were unable to provide us with the raw d ata to complete contingency tables. This meta analysis deals with thre e studies including 61 patients with septic shock. Data Extraction: Th ree independent reviewers extracted data on study design, intervention , outcome, and methodologic quality. The intraclass correlation coeffi cient was 0.7, The quality score of each study was 48, 60, and 61, on a scale of 104. Data Synthesis: Naloxone therapy was associated with s tatistically significant hemodynamic improvement (typical odds ratio: 0.241; 95% confidence interval: 0.08 to 0.68), The overall effect size was 0.89. However, a publication bias was possible. The case fatality rate was not decreased by naloxone (typical odds ratio: 0.60; 95% con fidence interval: 0.21 to 1.67); a chi-square analysis detected signif icant heterogeneity for the latter outcome (p < .05). Conclusions: Nal oxone improves blood pressure. However, the clinical usefulness of nal oxone to treat shock remains to be determined and additional randomize d clinical trials are needed to assess its usefulness.