Therapy of shock with naloxone: a meta-analysis.
OBJECTIVE
To evaluate the effectiveness of naloxone in human shock; and to estimate the methodologic quality of the clinical trials.


METHODS
Computerized bibliographic search on MEDLINE covering the period from January 1979 to July 1996, review of references of all papers found on the subject, and contact with primary investigators of eligible studies.


METHODS
To be included in this study, a paper should be a randomized, clinical trial published in a peer-reviewed journal evaluating naloxone in human shock, regardless of the patient's age (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 posteriori two studies whose authors were unable to provide us with the raw data to complete contingency tables. This meta-analysis deals with three studies including 61 patients with septic shock.


METHODS
Three independent reviewers extracted data on study design, intervention, outcome, and methodologic quality. The intraclass correlation coefficient was 0.7. The quality score of each study was 48, 60, and 61, on a scale of 104.


RESULTS
Naloxone therapy was associated with statistically 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% confidence interval: 0.21 to 1.67); a chi-square analysis detected significant heterogeneity for the latter outcome (p < .05).


CONCLUSIONS
Naloxone improves blood pressure. However, the clinical usefulness of naloxone to treat shock remains to be determined and additional randomized clinical trials are needed to assess its usefulness.
Boeuf
B
B
Department of Pediatrics, Sainte-Justine Hospital, Montreal, PQ, Canada.
Gauvin
F
F
Guerguerian
A M
AM
Farrell
C A
CA
Lacroix
J
J
Jenicek
M
M
D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D012769:Shock / Q000188:drug therapy* / Q000503:physiopathology
D009292:Narcotic Antagonists; D009270:Naloxone