IntroductionThis study evaluated the Metacognitive Enhancement Triad (MET) model, integrating peer-assisted learning (PAL), problem-based learning (PBL), and practice-enhanced cognitive learning (PCL), for improving first-year residents’ learning outcomes and National Medical Licensing Examination (NMLE) performance.MethodsA quasi-experimental study was conducted at a tertiary academic medical center. 24 first-year residents received conventional training (pre-intervention), while 22 received the MET intervention (post-intervention). The MET model comprised: (1) PAL groups formed by diagnostic assessment; (2) Constructivist PBL sessions led by mentors; (3) Clinical rotations restructured to align with NMLE content (PCL). Primary outcomes were NMLE scores and pass rates. Secondary outcomes were self-reported competencies and satisfaction measured on a 10-point Likert scale.ResultsThe post-intervention cohort showed significantly higher NMLE scores (429 ± 41 vs. 388 ± 46, p < 0.01) and pass rates (90.9% vs. 62.5%, p < 0.01). They also reported greater improvement in professionalism, integrated clinical proficiency, lifelong learning, and overall satisfaction (all p < 0.05).ConclusionThe MET model significantly enhanced NMLE performance and key competencies among first-year emergency medicine residents, offering an effective framework for residency training.

Background Muscle mass evaluation in ICU is crucial since its loss is related with long term complications, including physical impairment. However, quantifying muscle wasting with available bedside tools (ultrasound and bioimpedance analysis) must be more primarily understood. Bioimpedance analysis (BIA) provides estimates of muscle mass and phase angle (PA). The primary aim of this study was to evaluate muscle mass changes with bioimpedance analysis during the first 7 days after ICU admission. Secondary aims searched for correlations between muscular loss and caloric and protein debt. Methods Patients with an expected ICU-stay ≥ 72 h and the need for artificial nutritional support were evaluated for study inclusion. BIA evaluation of muscle mass and phase angle were performed at ICU admission and after 7 days. Considering the difference between ideal caloric and protein targets, with adequate nutritional macronutrients delivered, we calculated the caloric and protein debt. We analyzed the potential correlation between caloric and protein debt and changes in muscle mass and phase angle. Results 72 patients from September 1st to October 30th, 2019 and from August 1st to October 30th, 2021 were included in the final statistical analysis. Median age was 68 [59–77] years, mainly men (72%) admitted due to respiratory failure (25%), and requiring invasive mechanical ventilation for 7 [4–10] days. Median ICU stay was 8 [6–12] days. Bioimpedance data at ICU admission and after 7 days showed that MM and PA resulted significantly reduced after 7 days of critically illness, 34.3 kg vs 30.6 kg (p < 0.0001) and 4.90° vs 4.35° (p = 0.0004) respectively. Mean muscle loss was 3.84 ± 6.7 kg, accounting for 8.4% [1–14] MM reduction. Correlation between caloric debt (r = 0.14, p = 0.13) and protein debt (r = 0.18, p = 0.13) with change in MM was absent. Similarly, no correlation was found between caloric debt (r = -0.057, p = 0.631) and protein debt (r = -0.095, p = 0.424) with changes in PA. Conclusions bioimpedance analysis demonstrated that muscle mass and phase angle were significantly lower after 7 days in ICU. The total amount of calories and proteins does not correlate with changes in muscle mass and phase angle.

BACKGROUND:Trauma-induced coagulopathy (TIC) due to serious injuries significantly leads to increased mortality and morbidity among elderly patients. However, the risk factors of TIC are not well elucidated. This study aimed to explore the risk factors of TIC in elderly patients who have major trauma. METHODS:In this retrospective study, the risk factors for TIC in elderly trauma patients at a single trauma center were investigated between January 2015 and September 2020. The demographic information including gender, age, trauma parts, injury severity, use of blood products, use of vasopressors, need of emergency surgery, duration of mechanical ventilation, length of stay in the intensive care unit (ICU) and hospital, and clinical outcomes were extracted from electric medical records. Multivariate logistic regression analysis was performed to differentiate risk factors, and the performance of the model was evaluated using receiver operating characteristics (ROC) curves. RESULTS:Among the 371 elderly trauma patients, 248 (66.8%) were male, with the age of 72.5 ± 6.8 years, median injury severity score (ISS) of 24 (IQR: 17-29), and Glasgow coma score (GCS) of 14 (IQR: 7-15). Of these patients, 129 (34.8%) were diagnosed with TIC, whereas 242 (65.2%) were diagnosed with non-TIC. The severity scores such as ISS (25 [20-34] vs. 21 [16-29], P<0.001) and shock index (SI), (0.90±0.66 vs. 0.58 ± 0.18, P<0.001) was significantly higher in the TIC group than in the non-TIC group. Serum calcium levels (1.97±0.19 mmol/L vs. 2.15±0.16 mmol/L, P<0.001), fibrinogen levels (1.7±0.8 g/L vs. 2.8±0.9 g/L, P<0.001), and base excess (BE, -4.9±4.6 mmol/L vs. -1.2 ± 3.1 mmol/L, P<0.001) were significantly lower in the TIC group than in the non-TIC group. Multivariate logistic regression analysis revealed that ISS>16 (OR: 3.404, 95%CI: 1.471-7.880; P=0.004), SI>1 (OR: 5.641, 95%CI: 1.700-18.719; P=0.005), low BE (OR: 0.868, 95%CI: 0.760-0.991; P=0.037), hypocalcemia (OR: 0.060, 95%CI: 0.009-0.392; P=0.003), and hypofibrinogenemia (OR: 0.266, 95%CI: 0.168-0.419; P<0.001) were independent risk factors for TIC in elderly trauma patients. The AUC of the prediction model included all these risk factors was 0.887 (95%CI: 0.851-0.923) with a sensitivity and specificity of 83.6% and 82.6%, respectively. CONCLUSION:Higher ISS (more than 16), higher SI (more than 1), acidosis, hypocalcemia, and hypofibrinogenemia emerged as independent risk factors for TIC in elderly trauma patients.

Drowning is a major cause of preventable death and pathology worldwide.Every year,more than 295,000 people die from accidental drowning.Ninety percent of accidental drowning deaths occur in low-and middle-income countries,and nearly half occur in people under the age of 25.

OBJECTIVE:To compare the therapeutic effect and safety of restrictive versus massive fluid resuscitation in patients with traumatic hemorrhagic shock (TSH).METHODS:Ninety TSH patients treated in the ICU of the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2020 to January 2021 were recruited for this retrospective study. Among them, 47 cases received restrictive fluid resuscitation (RFR) after admission who were considered as the observation group (OG), while the other 43 cases were given massive fluid resuscitation (MFR) who were treated as the control group (CG). The clinical indices, coagulation function, blood gas analysis, mortality within 72 h, duration of mechanical ventilation, and ICU stay were compared between the two groups, and the amount of resuscitation fluid given and complications that occurred during treatment were recorded. Multivariate logistic regression analysis was used to screen the independent risk factors for complications.RESULTS:In comparison to the CG, the resuscitation time, infusion volume, and lactate level in the OG were lower after treatment, while the hemoglobin level and blood gas residual base value (BE) were higher. Besides, the activated partial thromboplastin time (APTT), thrombin time (TT) and prothrombin time (PT) levels and arterial blood carbon dioxide partial pressure (PaCO2) in the OG were lower, while arterial blood oxygen partial pressure (PaO2) and pH were higher. The duration of mechanical ventilation and ICU stay in the OG after treatment were lower, and there was no statistical difference in mortality and complication rates within 72 h. Lower mean arterial pressure (MAP), higher APACHE II (Acute Physiology and Chronic Health Evaluation II) and longer resuscitation time were independent risk factors for complications in patients with traumatic shock.CONCLUSION:TSH treatment with RFR can effectively accelerate patients' resuscitation with less volume of infusion of resuscitation fluid, reduced time of mechanical ventilation and ICU hospitalization, and promote the recovery of coagulation function. It has good effects and is very suitable for clinical application.

OBJECTIVE:To assess the ability of the acute physiology and chronic health evaluation II (APACHE II) and trauma-injury severity score (TRISS) in predicting mortality in intensive care unit (ICU) trauma patients.METHODS:Databases of PubMed, Cochrane Library, SinoMed, CNKI were retrieved from January 1980 to December 2020. The ability of the APACHE II and the TRISS to predict mortality in the ICU trauma patients was compared in the retrieval literatures. The relevant literatures were screened by two researchers independently. The data of the included literatures were extracted, and the quality of the included literatures was evaluated. MetaDiSc 1.4 software was used to test the heterogeneity among studies. Meta-analysis was performed on diagnostic accuracy indicators and the summary receiver operator characteristics curve (SROC curve) was fitted. The area under SROC curve (AUC) of the two scores was compared. Deek test was used to analyze literature publication bias.RESULTS:Six studies were selected with 4 054 patients involved with medium and high quality. Meta-analysis results showed that APACHE II and TRISS had low sensitivity [the pooled sensitivity and 95% confidence interval (95%CI) was 0.48 (0.41-0.55) and 0.51 (0.41-0.62)], high specificity [the pooled specificity and 95%CI was 0.96 (0.93-0.97) and 0.98 (0.95-0.99)], the pooled diagnostic odds ratio (DOR) and 95%CI was 20 (14-28) and 46 (18-120), and overall good performance in terms of AUC [the AUC and 95%CI was 0.79 (0.75-0.82) and 0.80 (0.76-0.83)] in predicting the prognosis of ICU trauma patients. There was no statistical difference in AUC between the two scores (Z = 1.542, P > 0.05). Deek funnel plot showed little publication bias.CONCLUSIONS:Both APACHE II and TRISS scores could accurately predict mortality in ICU trauma patients.

钝性创伤性主动脉损伤(blunt thoracic aortic injury,BTAI)是一种由于快速减速损伤导致的严重血管损伤,80％左右的钝性创伤性主动脉损伤患者在被运送至医疗救治单位/创伤中心前就因大量失血而导致丧失抢救机会;而可以成功被运送至到医院的这一部分患者会因夹层导致的各种并发症或者并发的其他致命性创伤,大约会在24～48h内死亡.而真正生存下来的患者往往也会有多发伤,包括心脏损伤、肋骨骨折、血胸和腹腔脏器损伤,救治的成功率也极低.创伤后主动脉夹层不常见,但是单纯损伤合并下肢缺血横纹肌溶解及顽固性高钾血症报道甚少[1-2].

Purpose The study aimed to examine the changing incidence of geriatric trauma and evaluate the predictive ability of different scoring tools for in-hospital mortality in geriatric trauma patients. Methods Annual reports released by the National Trauma Database (NTDB) in the USA from 2005 to 2015 and the Trauma Register DGU® in Germany from 1994 to 2012 were analyzed to examine the changing incidence of geriatric trauma. Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level I trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into the survival and non-survival group. The differences of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SPAS II (simplified acute physiology score II) between two groups were evaluated. Then, the areas under the receiver-operating characteristic curve (AUC-ROC) of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients were calculated. Results The analysis of the NTDB showed that the increase in the number of geriatric trauma ranged from 18 to 30% between 2005 and 2015. The analysis of the DGU® showed that the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥ 60 years rose from 16.5 to 37.5%. The findings from the secondary analysis showed that 164 (52.73%) patients died in the hospital. The ISS, NISS, APACHE II, and SAPS II in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUCs of the ISS, NISS, TRISS, APACHE II, and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients were 0.807, 0.850, 0.828, 0.715, and 0.725, respectively. Conclusion The total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the APACHE II and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients.

Objective: The aim of this study was to explore the effects and safety of low-dose hydrocortisone in patients with septic shock. Methods: The PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched from database inception until 1 August 2018. Two reviewers performed literature selection, data extraction, and quality evaluation independently. Results: Twelve randomized controlled trials were included in this meta-analysis. The combined results showed that low-dose hydrocortisone use had no survival benefit in patients with septic shock (relative risk = 1.09; 95% confidence interval = 0.88–1.05; P = 0.37). But low-dose hydrocortisone use was useful for shock reverse (relative risk = 1.09; 95% confidence interval = 1.00–1.19; P = 0.04) and in shortening the time of vasopressor support (weighted mean difference = −1.79, 95% confidence interval = −2.05 to −1.52; P < 0.00001). In addition, use of low-dose hydrocortisone was associated with a higher risk of hyperglycemia (relative risk = 1.21; 95% confidence interval = 1.04–1.40; P = 0.01) and hypernatremia (relative risk = 6.34; 95% confidence interval = 1.19–33.81; P = 0.03). There was no significant improvement of intensive care unit mortality (relative risk = 1.11; 95% confidence interval = 0.93–1.33; P = 0.23) or hospital mortality (relative risk = 1.08; 95% confidence interval = 0.94–1.24; P = 0.29), length of intensive care unit (weighted mean difference = −1.84; 95% confidence interval = −5.80 to 2.11; P = 0.36) or length of hospital (weighted mean difference = 0.11; 95% confidence interval = −2.06 to 2.29; P = 0.98), and time of mechanical support (weighted mean difference = −0.69; 95% confidence interval = −1.76 to −0.38; P = 0.20) with the use of low-dose hydrocortisone. There was no significant difference in secondary infection (relative risk = 1.04; 95% confidence interval = 0.91–1.18; P = 0.57), recurrence of shock (relative risk = 1.47; 95% confidence interval = 0.64–3.39; P = 0.36), and gastrointestinal bleeding (relative risk = 1.41; 95% confidence interval = 0.89–2.22; P = 0.14) with the use of low-dose hydrocortisone. Conclusion: Although there was no effect of low-dose hydrocortisone on survival of patients with septic shock, it is associated with a higher rate of shock reversal and shortening duration of vasopressor support; thus, low-dose hydrocortisone may be an alternative drug in septic shock patients who are refractory to fluid resuscitation and vasopressors.

Background: High-quality chest compression is crucial for cardiac arrest patients. However, only few studies are focusing on the optimal compression point. Objective: The aim of this study was to explore the optimal compression point based on chest-computed tomography. Methods: We retrospectively selected 166 adult health subjects between January 2018 and May 2018 in a university-affiliated hospital. Results: The median length of sternum was 14.9 cm. The median length from the inter-nipple line to the distal end of sternum was 1.0 cm. The median length from the point at which the maximal left ventricular diameter projected onto the sternum to the distal end of the sternum was −1.4 (–2.2 to 0.0) cm. The median value of the length from the inter-nipple line to the distal end of sternum plus the length from the point at which the maximal left ventricular diameter projected onto the sternum to the distal end of the sternum was 2.0 (1.0–3.1) cm. Conclusion: One size does not fit all. The point recommended by the current guideline may not appropriate for Chinese person. Further studies are required focusing on individual chest compression during cardiopulmonary resuscitation.

Purpose: The aim of this study was to describe the age change tendency of trauma patients and to test the accuracy of different scoring tools in prediction of in-hospital mortality in case of geriatric trauma.Methods: Annual reports released by the National Trauma Database (NTDB) in the United States from 2005 to 2015 and the Trauma Register DGU® in German from 1994 to 2012 were used to describe the age change tendency of trauma patients. Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level Ⅰ trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into survival group and non-survival group. Receiver Operating Characteristic Curve (ROC) analysis was used to evaluated the predictive performance of the ISS (injury severity score); NISS (new injury severity score), APACHE Ⅱ (Acute Physiology and Chronic Health Evaluation Ⅱ), SPAS Ⅱ (simplified acute physiology score Ⅱ) and TRISS (Trauma and Injury Severity Score) in prediction of in-hospital mortality among geriatric trauma patients. Results: The analysis of the NTDB showed the proportion of geriatric trauma increased from 18% to 30% from 2005 to 2015. The analysis of the DGU® showed the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥60 rose from 16.5% to 37.5%. The secondary analysis indicated one hundred and sixty-four (52.73%) patients died in the hospital. The ISS, NISS, APACHE Ⅱ, and SAPS Ⅱ in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUC of the ISS, NISS, TRISS, APACHE Ⅱ, and SAPS Ⅱ was 0.807, 0.850, 0.828, 0.715 and 0.725, respectively.Conclusion: The total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the accuracy of the APACHE Ⅱ and SAPS Ⅱ to predict in-hospital mortality in case of geriatric trauma.

PurposeThe aim of this study was to explore the effects of an enteral nutrition (EN) feeding protocol in critically ill patients.MethodsThis was a prospective multi-center before-after study. We compared energy related and prognostic indicators between the control group (pre-implementation stage) and intervention group (post-implementation stage). The primary endpoint was the percentage of patients receiving EN within 7 days after ICU admission.Results209 patients in the control group and 230 patients in the intervention group were enrolled. The implementation of the EN protocol increased the percentage of target energy reached from day 3 to day 7, and the difference between two groups reached statistical significance in day 6 (P = .01) and day 7 (P = .002). But it had no effects on proportion of patient receiving EN (P = .65) and start time of EN (P = .90). The protocol application might be associated with better hospital survival (89.1% vs 82.8%, P = .055) and reduce the incidence of EN related adverse (P = .004). There was no difference in ICU length of stay, duration of mechanical ventilation and ICU cost.ConclusionThe implementation of the enteral feeding protocol is associated with improved energy intake and a decreased incidence of enteral nutrition related adverse events for critically ill patients, but it had no statistically beneficial effects on reducing the hospital mortality rate.Trial registrationClinicalTrials.gov, NCT02976155. Registered November 29, 2016- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02976155.

Abstract Backgrounds The aim of this study is investigating the benefits and harms of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS). Methods We comprehensively searched PubMed, EMBASE, and Cochrane library for randomized controlled trials comparing NMBAs to any other comparator. We pooled data using relative risk (RR) for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes, with 95% confidence intervals. We assessed the quality of included studies using the Cochrane tool and levels of evidence using the GRADE method. Results Finally, six RCTs (n = 1557 patients) were eligible for analysis. The results showed NMBAs use was not associated with reduced 28 days mortality (RR 0.78; 95% CI, 0.58 to 1.06; P = 0.11), 90 days mortality (RR, 0.92; 95% CI, 0.81 to 1.04; P = 0.16), and intensive care unit (ICU) mortality (RR, 0.90; 95% CI, 0.79 to 1.03; P = 0.13) in patients with ARDS. However, 21–28 days mortality was slightly lower in patients received NMBAs (RR 0.73; 95% CI, 0.54 to 0.99; P = 0.04; I2 = 53%). Besides, NMBAs use could improve the PaO2/FiO2 ratio at 48 and 72 h, decrease plateau pressure and PEEP at 72 h. Additionally, NMBAs had no significant effects on days free of ventilation at day 28 (WMD, 0.55; 95% CI, − 0.46 to 1.57; P = 0.29), days not in ICU at day 28 (WMD, 0.12; 95% CI, − 0.85 to 1.08; P = 0.82), ICU-acquired weakness (RR, 1.23; 95% CI, 0.99 to 1.93; P = 0.06). Finally, NMBAs use was associated with a lower risk of barotrauma (RR, 0.55; 95% CI, 0.35 to 0.85; P = 0.007). Conclusion In patients with respiratory distress syndrome, NMBAs may be beneficial in reverse refractory hypoxemia and may be associated with reduced short-term mortality and incidence of barotrauma. However, there is no significant effects of NMBAs on mid-term and long-term mortality, and further studies are required.

Background. In recent years, serious injuries associated with extreme climate, earthquakes, terrorism, and other natural and man-made disasters have occurred frequently throughout the world. A surge in medical demand that extends beyond local medical surge capacity in mass casualty incidents following major disasters is common. Materials and Methods. We reviewed and analyzed emergency medical rescue efforts after major disasters in recent years to elaborate the precision strategy of augmenting medical surge capacity for disaster response. Results. Precision augmentation of medical surge capacity for disaster response can be achieved through several measures. These include (1) release of internal capacity through precision launching or through upgrading the levels of response, (2) precision support for medical surge capacity from external efforts, (3) centralized response, and (4) altering standards of care. We should adopt precision augmentation of medical surge capacity according to the specific situation. Conclusions. Augmentation of medical surge capacity as a basic strategy can be used to achieve effective disaster response. In disaster response, due to the complexity of disaster medical capacity amplification, it is important to select the appropriate medical capacity strategy accurately according to the actual disaster situation.

创伤是当今世界面临的重大卫生问题.优化创伤患者早期评估的流程,缩短受伤至确定性治疗的时间至关重要.影像学检查作为重要的诊断手段,在创伤患者早期评估中发挥了关键作用,为确定性治疗提供依据.本文介绍了创伤影像学检查常用手段的优缺点和价值,包括X线片、CT、介入放射学、MRI、超声,并探讨了放射安全问题,为临床进一步优化创伤影像学评估的策略提供参考.

Background:Hollow organs perforation is a life-threatening condition. Early diagnosis and emergent intervention are important. Bedside ultrasound may be an alternative diagnostic tool for this condition.Objective:The aim of this study was to explore the diagnostic value of ultrasound of pneumoperitoneum in emergent or critical conditions through meta-analysis.Methods:PubMed, EMBASE, and Cochrane Library were systematically searched for potential studies. Then, two reviewers performed the processes of study selection, data extraction, and quality assessment independently. Finally, diagnostic indexes were analyzed with STATA 12.0 software (Serial No. 40120519635).Results:A total of five studies with moderate to high quality were eligible for meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio and their 95% confidence interval were 0.91 (95% confidence interval = 0.86–0.94), 0.96 (95% confidence interval = 0.75–0.99), 22.05 (95% confidence interval = 3.10–156.96), and 0.10 (95% confidence interval = 0.07–0.15), respectively. The area under the summary receiver operating characteristic curve was 0.92 (95% confidence interval = 0.90–0.94).Conclusion:Abdominal ultrasound is a useful alternative tool in diagnosing of pneumoperitoneum. However, due to limited evidence, it is not yet indicated for routine clinical use.

The aim of this study was to evaluate the effects and safety of vasopressin receptor agonists in patients with septic shock. PubMed, EMBASE, and Cochrane library were searched for randomized controlled trials evaluating the effects of vasopressin receptor agonists in septic shock patients. Two reviewers performed literature selection, data extraction, and quality evaluation independently. The primary outcome was mortality. And secondary outcomes included intensive care unit (ICU) length of stay, duration of mechanical ventilation, and incidence of adverse events. In addition, a trial sequential analysis (TSA) was performed. Twenty studies were eligible for meta-analysis. The results showed vasopressin receptor agonists use was associated with reduced mortality (relative risk (RR) 0.92; 95% confidence interval (CI) 0.84 to 0.99; I2 = 0%). Nevertheless, they had no significant effects on ICU length of stay (mean deviation (MD) − 0.08, 95% CI, − 0.68 to 0.52, I2 = 0%) and duration of mechanical ventilation (MD − 0.58, 95% CI − 1.47 to 0.31, I2 = 57%). Additionally, there was no significant difference in total adverse events between two groups (RR 1.28, 95% CI 0.87 to 1.90, I2 = 57%), but vasopressin receptor agonists administration could significantly increase the risk of digital ischemia (RR 4.85, 95% CI 2.81 to 8.39, I2 = 26%). Finally, there was no statistical difference of cardiovascular events (RR 0.91, 95% CI 0.53 to 1.57, I2 = 1%), arrhythmia (0.77, 95% CI 0.48 to 1.23, I2 = 23%), mesenteric ischemia (0.83, 95% CI 0.44 to 1.55, I2 = 0%), diarrhea (2.47, 95% CI 0.77 to 7.96, I2 = 49%), cerebrovascular events (1.36, 95% CI 0.18 to 10.54, I2 = 0%), and hyponatremia (1.47, 95% CI 0.84 to 2.55, I2 = 0%) between two groups. Egger’s test showed there was no significant publication bias among studies (P = 0.36). The use of vasopressin might result in reduced mortality in patients with septic shock. An increased risk of digital ischemia must be taken into account.