Pulmonary Vasodilator and Inodilator drugs in Cardiac Surgery: a Systematic Review with Bayesian Network Meta-analysis

Objective. We performed a systematic review to evaluate the effect of pharmacological therapy pulmonary hypertension in perioperative setting elective cardiac surgery (PROSPERO CRD42023321041).Design Systematic randomized controlled trials with Bayesian network meta-analysis.Setting searched on biomedical databases use inodilators and vasodilators adult surgery, in-hospital mortality as primary outcome duration ventilation, length stay intensive care unit, stage 3 acute kidney injury, cardiogenic shock requiring mechanical support, change mean artery pressure secondary outcomes.Participants Twenty-eight studies randomizing 1879 patients were included.Interventions Catecholamines non-catecholamine inodilators, arterial vasodilators, or their combination considered eligible interventions compared placebo standard care.Measurements Main Results Ten reported assigned 855 12 different interventions. Only inhaled prostacyclin was supported by statistically discernible improvement mortality, number-need-to-treat estimate at least 3.3, but wide credible interval (RR 1.26*10−17-0.7). Inhaled nitric oxide associated reduction ICU stay, while none included reached evident difference comparison usual other clinical outcomes.Conclusions only which is treatment hypertension. However, available evidence has significant limitations, mainly low number events imprecision.