When people go into shock, their blood pressure drops and may be too low to sustain life. One theory about the cause of this is the effect of the opiates that the body produces after major blood loss or trauma. Naloxone is a drug that counteracts the effects of opiates. It has been tried as a treatment to reduce the impact of shock. This review of trials found that giving naloxone to people in shock improves their blood pressure. It is not clear whether or not this improves their overall condition or reduces their chances of dying. More trials are needed.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 7, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Boeuf B, Poirier V, Gauvin F, Guerguerian A-M, Roy C, Farrell C, Lacroix J. Naloxone for shock. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD004443. DOI: 10.1002/14651858.CD004443

Editorial Group: Injuries Group

This version first published online: October 20. 2003
Last assessed as up-to-date: December 5. 2008

Abstract

Background

There is pre-clinical evidence, involving several animal species, suggesting that opioid peptides play a role in the physiopathology of shock (endotoxic, hypovolemic, cardiogenic, spinal, anaphylactic). Many case reports have suggested that naloxone (an opiate antagonist) might be an effective treatment for shock in humans, but others have not supported such a point of view. This controversy led us to undertake a meta-analysis of the available evidence on the efficacy of naloxone as a treatment measure for shock in humans.

Objectives

To evaluate the effectiveness and safety of naloxone in human shock and to estimate the methodological quality of the clinical trials.

Search strategy

We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE (Ovid SP), PubMed, EMBASE (Ovid SP), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), and ISI Web of Science: Conference Proceedings Citation Index-Science (CPCI-S) (to December 2008). In order to identify further studies the reference lists of all included papers were examined and the primary investigators of eligible studies were contacted.

Selection criteria

Randomized controlled trials evaluating naloxone in human shock, regardless of the patient's age (adult, child, or neonate).

Data collection and analysis

Three independent review authors extracted data on study design, intervention, outcomes, and methodological quality.

Main results

Three independent readers reviewed 120 publications and selected six clinical trials. Overall agreement on study selection was perfect (concordance: 100%). The meta-analysis includes six studies involving 126 patients with septic, cardiogenic, hemorrhagic, or spinal shock.

Naloxone therapy was associated with statistically significant hemodynamic improvement (odds ratio 0.24; 95% confidence interval (CI) 0.09 to 0.68). The mean arterial pressure was significantly higher in the naloxone groups than in the placebo groups (weighted mean difference +9.33 mm Hg; 95% CI 7.07 to 11.59). No heterogeneity was found for this outcome. The death rate was lower in the naloxone group (odds ratio 0.59; 95% CI 0.21 was 1.67) but this was consistent with the play of chance. A significant heterogeneity was detected for the latter outcome (P < 0.05).

Authors' conclusions

Naloxone improves blood pressure, especially mean arterial blood pressure. However, the clinical usefulness of naloxone to treat shock remains to be determined and additional randomized controlled trials are needed to assess its usefulness.

top of page | contact us | about this site | disclaimer | privacy