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The International Journal of Medical Science and Health Research, published by International Medical Journal Corp. Ltd. is dedicated to providing physicians with the best research and important information in the world of medical research and science and to present the information in a format that is understandable and clinically useful. Committed to publishing multidisciplinary research that spans the entire spectrum of healthcare and medicine access, The American Journal of Medical Science and Health Research aims at an international audience of pharmacists, clinicians, medical ethicists, regulators, and researchers, providing an online forum for the rapid dissemination of recent research and perspectives in this area.

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Articles 516 Documents

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A Comprehensive Systematic Review of Association of SGLT2 Inhibitors to Renal Protection in Patients with Diabetic Kidney Disease Afrizal Adi Nugroho; Fatimah Yasin
The International Journal of Medical Science and Health Research Vol. 30 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/8tds9p56

Introduction: Diabetic kidney disease (DKD) remains a leading cause of end-stage renal disease worldwide despite optimal renin-angiotensin-aldosterone system blockade. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have emerged as potential renoprotective agents, yet the totality of evidence across diverse study designs, populations, and renal outcomes requires comprehensive synthesis. This systematic review aims to evaluate the association between SGLT2 inhibitors and renal protection in patients with DKD, synthesizing evidence from randomized controlled trials, observational studies, and meta-analyses. Methods: A comprehensive systematic review was conducted following PRISMA guidelines. We screened studies based on predefined criteria including adult patients (≥18 years) with DKD, SGLT2 inhibitor intervention, renal outcomes reported (eGFR decline, albuminuria reduction, progression to ESRD), study designs including RCTs and observational studies, follow-up ≥12 weeks, and exclusion of case reports/series. Data extraction encompassed study characteristics, SGLT2 inhibitor details, population demographics, renal outcomes, effect sizes, mechanisms, and adverse effects. Methodological quality was assessed using Cochrane risk of bias tools and Newcastle-Ottawa Scale. Results: From the evidence base comprising over 90,000 participants across landmark trials (CREDENCE, DAPA-CKD, EMPA-KIDNEY) and numerous meta-analyses, SGLT2 inhibitors consistently demonstrated significant renal protection. Pooled analyses showed 30-40% risk reduction in composite renal outcomes (HR 0.61-0.71, 95% CI), 25-35% reduction in albuminuria progression, and 30% slower eGFR decline. Benefits were consistent across subgroups including baseline eGFR <30 mL/min/1.73m², elderly patients, and varying albuminuria levels. Hemodynamic mechanisms (reduced intraglomerular pressure via tubuloglomerular feedback) and metabolic effects (glycemic control, weight reduction) contributed independently of HbA1c changes. Safety analysis revealed initial eGFR dip (typically <5 mL/min/1.73m², reversible) without increased acute kidney injury risk; genital infections were increased but rarely severe. Discussion: This comprehensive synthesis confirms SGLT2 inhibitors as foundational therapy for renal protection in DKD, with benefits extending across CKD stages 2-4 and independent of diabetes duration or glycemic control. The consistency between RCT efficacy and real-world effectiveness supports broad implementation. Mechanisms involve hemodynamic normalization, anti-inflammatory effects, and improved mitochondrial function. Conclusion: SGLT2 inhibitors provide robust, multi-mechanistic renal protection in DKD with favorable safety profiles. We recommend their early initiation in DKD patients regardless of glycemic control, with monitoring for reversible eGFR decline and volume status. Future research should address optimal combination strategies with newer agents and long-term outcomes beyond five years.

The Comprehensive Systematic Review of Readmission Rates for Patients with Pleural Effusion Ian Aji Prahasta; Tika Indriati; Lydia Arieta
The International Journal of Medical Science and Health Research Vol. 31 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/erke1e19

Introduction: Pleural effusion is a common clinical condition associated with significant healthcare burden, yet readmission rates and their determinants remain poorly characterized across different etiologies. This systematic review synthesizes evidence on readmission rates, risk factors, treatment interventions, and clinical outcomes in adult patients with pleural effusion. Methods: A systematic review was conducted using rigorous screening criteria including studies reporting readmission outcomes in adult pleural effusion patients. Data were extracted on patient populations, readmission rates, risk factors, readmission characteristics, interventions, clinical outcomes, and study design. A total of 111 studies published were included, comprising retrospective and prospective cohort studies, database analyses, and interventional trials. Results: Thirty-day all-cause readmission rates ranged from 20.7-38.3% for malignant pleural effusion (MPE), 1.4-20.8% for trauma-related effusions, 9.1-12.5% for post-cardiac surgery, and 10.5-35.9% for heart failure. Pleural effusion was the direct cause of readmission in 24.3-69.5% of MPE cases. Key risk factors included older age, multiple comorbidities, thoracentesis-only management (vs definitive procedures), presence of effusion at discharge, and discharge to care facilities. Definitive procedures (indwelling pleural catheters, pleurodesis) significantly reduced readmissions compared to serial thoracentesis (p<0.001). System-level interventions including specialized pleural clinics and multidisciplinary pathways reduced hospital admissions by 24-47%. Readmission was associated with substantially increased mortality (17-20% for MPE) and healthcare costs (>$15,000 per readmission). Discussion: This review identifies significant heterogeneity in readmission rates across effusion etiologies and demonstrates that readmissions are frequently preventable through definitive management strategies and coordinated care models. The evidence strongly supports transitioning from reactive, repetitive drainage to proactive, definitive interventions and systematic care pathways. Conclusion: Readmission in pleural effusion patients is common, costly, and associated with poor outcomes. Implementation of definitive procedures and specialized pleural services represents evidence-based strategies to reduce readmission burden. Future research should focus on prospective validation of risk prediction models and comparative effectiveness of definitive interventions across diverse populations.

CASE REPORT MYOCARDITIS IN UNIDENTIFIED SNAKE BITE Tsani Fauzi Elpani; Yandi Arifudin
The International Journal of Medical Science and Health Research Vol. 31 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/qw4ya918

Background : Venomous snakebites are rare, with an estimated 1,000 cases annually, resulting in approximately 5 deaths. Venomous snakebites are a medical emergency that can result in life-threatening clinical effects. Cardiovascular complications in snakebite patients include myocarditis, shock, ventricular dysrhythmias, and cardiac arrest. Myocarditis caused by viper envenomation in humans rarely happens, but it could be dangerous if not detected and treated early. Case Illustration: In the afternoon, a 74-year-old man made a fuss scene of a snake bite on his left leg, which happened in a rice field. The shape of the snake cannot be identified. The sense of the leg becoming increasingly swollen and turning purple. Additional complaints were shortness of breath (+). Risk factors were uncontrolled hypertension and smoking regularly, one pack a day. The bites are showing fang marks (+), swelling (+), and edema (+). On the second day, the bruises from the bite had spread. Supporting examinations revealed leukocytosis, increased troponin I, an ECG recording showed ischemia in the inferior and anterolateral regions, and a PA chest X-ray showed cardiomegaly. Echocardiography results showed hypokinetic inferior septal, mitral regurgitation, tricuspid regurgitation, aortic regurgitation, and LVEF 37%. The treatment provided included immobilization of the bite site with a splint, administration of SABU, cefotiam, spironolactone, ramipril, and furosemide. Conclusion : Venomous snakebites can cause adverse cardiovascular events. One of the complications, myocarditis, occurs as a direct result of the venom's toxins, which can damage myocardial cells.

Predictive Efficacy of the STOP-BANG Scoring System in Obstructive Sleep Apnea After Multilevel Airway Reconstructive Surgery: A Comprehensive Clinical Case Study Analysis Fierda Ovita Azhari; Gustav Syukrinto
The International Journal of Medical Science and Health Research Vol. 31 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/kz5fpj81

Obstructive Sleep Apnea (OSA) is a sleep disorder characterized by recurrent collapse of the upper airway. The STOP-BANG questionnaire has been validated as a highly sensitive screening tool to identify surgical patients at high risk for OSA. This report aims to evaluate multilevel surgical management in a patient with a high STOP-BANG score and review the literature regarding its clinical efficacy. A 55-year-old male presented with chronic snoring, daytime fatigue, and witnessed apnea episodes over the last six months. Physical examination revealed a Body Mass Index (BMI) of 28.4 Kg/m2, a neck circumference of 45 cm, tonsillar hypertrophy, an elongated uvula, and turbinate hypertrophy. The patient's STOP-BANG score was 6, indicating a high risk for moderate-to-severe OSA. A STOP-BANG score ≥ 5 has a strong correlation with OSA severity and an increased risk of postoperative respiratory complications. Multilevel surgery is more effective than single-level procedures because it targets multiple collapse sites simultaneously (nasal and oropharyngeal). Integrating the STOP-BANG score into preoperative evaluations allows for accurate risk stratification. Multilevel surgery in well-selected patients can provide significant symptomatic improvement and reduce the long-term morbidity burden of OSA.

How Do Specific Nutritional Interventions (e.g., Enteral Nutrition, Protein Supplementation, Micronutrient Support) Affect Mortality, Length of Hospital Stay, and Recovery in Patients with Pneumonia? : A Systematic Review Bayu Anggara H
The International Journal of Medical Science and Health Research Vol. 31 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/c74dft31

Introduction: Pneumonia remains a leading cause of morbidity and mortality worldwide, with malnutrition significantly exacerbating poor clinical outcomes. Despite growing interest in nutritional interventions, evidence regarding their specific effects on mortality, hospital stay, and recovery in pneumonia patients remains heterogeneous and inconclusive. Methods: This systematic review synthesized evidence from 57 studies evaluating nutritional interventions in pneumonia patients, including 12 randomized controlled trials, 6 systematic reviews/meta-analyses, and 39 observational studies. Studies were screened based on predefined criteria including primary pneumonia diagnosis, specific nutritional interventions, relevant clinical outcomes, and adult populations. Data extraction encompassed intervention characteristics, patient demographics, comparator groups, mortality, length of stay, and recovery indicators. Results: Early enteral nutrition initiated within 24-48 hours significantly reduced mortality (OR 0.45, 95% CI 0.21-0.95, p=0.038) and shortened hospital LOS by 3.54 days (p<0.00001). Each 30g/day increase in protein intake was associated with 24% reduced 60-day mortality (OR 0.76, p<0.001). Enteral nutrition demonstrated superior outcomes compared to parenteral nutrition across mortality (13.8% vs 27.1%, p=0.003), LOS (18.0 vs 28.0 days, p<0.05), and complication rates. High-protein feeding (1.8-2.2 g/kg/d) significantly attenuated muscle atrophy (13.97% vs 18.96%, p<0.001). Individualized nutritional programs reduced readmission by 77% (p=0.03) in malnourished elderly. Discussion: Nutritional interventions demonstrate clinically meaningful benefits when appropriately timed, dosed, and delivered via enteral routes. Heterogeneity in mortality findings reflects differential effects of intervention timing, nutritional adequacy thresholds, and baseline nutritional risk. Conclusion: Early enteral nutrition with adequate protein delivery should be standard care in hospitalized pneumonia patients. Future research should focus on optimal protein dosing, immunonutrition strategies, and post-discharge nutritional rehabilitation.

The Comprehensive Systematic Review of Diagnostic Accuracy of Rapid Point of Care Tests for Syphillis Hana Shabrina Purnama; Gema Putra Bangsa
The International Journal of Medical Science and Health Research Vol. 31 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/t50h1w43

Introduction: Syphilis remains a significant global public health challenge, with congenital syphilis continuing as a leading cause of preventable stillbirth and neonatal death. Rapid point-of-care tests (POCTs) offer potential to expand screening access in resource-limited settings; however, comprehensive evidence synthesis regarding their diagnostic accuracy across diverse populations and test types is required to inform global policy. Methods: This systematic review synthesised evidence from 159 diagnostic accuracy studies identified through comprehensive database searches. Studies evaluating treponemal-only, nontreponemal-only, or dual treponemal/nontreponemal rapid tests against accepted reference standards (TPPA, TPHA, FTA-Abs, RPR, VDRL) were included. Data extraction encompassed test characteristics, study populations, reference standards, diagnostic accuracy metrics, performance modifiers, and methodological quality. Synthesis was structured by test category, specimen type, syphilis stage, HIV status, and testing conditions. Results: Treponemal-only tests demonstrated consistently high specificity (94.1–100%) but variable sensitivity (59.6–100%), with Abbott Determine TP (26 studies) and SD Bioline Syphilis 3.0 (18 studies) most extensively evaluated. Dual treponemal/nontreponemal tests (Chembio DPP Syphilis Screen & Confirm, SD Bioline HIV/Syphilis Duo) showed excellent treponemal component performance (sensitivity 66.0–96.7%; specificity 97.2–99.3%), but nontreponemal component sensitivity was substantially lower (42.9–94.2%), particularly at low RPR titres. Test sensitivity was significantly enhanced in high-titre (≥1:8) active syphilis (94.6–100%) and reduced in primary syphilis (77.3–100%) and when using fingerprick whole blood versus serum/plasma. Field-based evaluations generally yielded lower accuracy estimates than laboratory studies. Performance in HIV co-infected populations varied, with some studies demonstrating maintained or enhanced sensitivity but reduced specificity. Discussion: This review identifies critical research gaps including limited standardisation of reference standards and case definitions, insufficient reporting of blinding procedures, heterogeneous definitions of active syphilis, underrepresentation of primary syphilis cases, and few head-to-head comparisons of multiple test brands. The novelty of this synthesis lies in its comprehensive stratification of performance by test type, specimen, disease stage, and population subgroup, enabling nuanced, context-specific test selection guidance. Conclusion: Rapid syphilis POCTs demonstrate sufficient accuracy for screening in resource-limited settings, particularly for high-titre active infections. Treponemal-only tests effectively rule out infection but cannot distinguish active from past disease. Dual tests offer improved clinical utility for identifying active syphilis requiring immediate treatment, although reduced nontreponemal component sensitivity at low titres may result in missed active infections. Test selection should be guided by local epidemiology, prevalence, available resources, and specific programmatic objectives. Rigorous training, quality assurance, and confirmatory testing algorithms remain essential implementation prerequisites.

A Comprehensive Systematic Review of Relationship between Surgery Waiting Time and Perforation Rate in Acute Appendicitis Putra Intan Sanjaya; Nikma Nur Fadhila
The International Journal of Medical Science and Health Research Vol. 31 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/n7fbc011

Introduction: Acute appendicitis is one of the most common surgical emergencies worldwide, with appendiceal perforation representing a critical complication associated with significant morbidity. The relationship between surgical waiting time and perforation risk remains controversial, with conflicting evidence regarding the safety of in-hospital delay. This systematic review aims to evaluate the association between waiting time for appendectomy and perforation rates in acute appendicitis, identify population-specific risks, and synthesize evidence for clinical practice guidance. Methods: A systematic review was conducted using comprehensive literature screening. Studies were included if they examined patients with acute appendicitis, reported measurable waiting time intervals, documented perforation outcomes, and employed appropriate comparative study designs. Data extraction encompassed waiting time definitions, perforation criteria, study population characteristics, statistical relationships, perforation rates by time categories, confounding factors, and secondary outcomes. Harvard citation style was applied throughout. Results: Eighty-nine studies published were analyzed, comprising retrospective cohorts (n=67), prospective cohorts (n=12), randomized controlled trials (n=2), cross-sectional studies (n=7), and one systematic review. Sample sizes ranged from 50 to 683,590 patients. Overall perforation rates varied from 7.5% to 72.5%, with most studies reporting 10-30%. For pre-hospital delay (symptom duration), consistent positive association with perforation was demonstrated, with odds ratios increasing from 2.84 for >24-hour delay to 6.6 for >36-hour symptoms (Bickell et al., 2006; Sadot et al., 2013). However, for in-hospital delay, findings were discordant. The PERFECT randomized controlled trial found no significant difference in perforation rates between <8-hour (8%) and <24-hour (9%) surgical windows (absolute risk difference 0.6%, 95% CI -2.1 to 3.2; Jalava et al., 2023). Conversely, pediatric studies demonstrated significant associations, with every hour of delay increasing perforation odds by 2% (AOR 1.02, 95% CI 1.00-1.04; Meltzer et al., 2016). High-risk subgroups including elderly patients, those with appendicoliths, and patients with marked inflammatory markers demonstrated accelerated perforation risk with in-hospital delay (Jeon et al., 2018; Hanson et al., 2019). Discussion: The relationship between surgical waiting time and appendiceal perforation is fundamentally dichotomous. Pre-hospital delay consistently predicts perforation at presentation, representing irreversible disease progression. In contrast, in-hospital delay of up to 24 hours appears safe for carefully selected adults with uncomplicated appendicitis, likely attributable to preoperative antibiotics and modern diagnostic accuracy. However, this safety window does not extend uniformly across populations. Pediatric patients demonstrate time-dependent perforation risk even within 24 hours, potentially reflecting anatomical and physiological differences in disease progression (Serres et al., 2017; Stevenson et al., 2017). Elderly patients present with attenuated symptoms yet accelerated perforation, warranting expedited surgical intervention (F. Rondelli et al., 2019). The presence of appendicolith confers 2.2-fold increased risk of progression to complicated appendicitis within 12 hours, mandating prioritized surgical scheduling (M. Prayle et al., 2023). Secondary outcomes including length of stay and surgical site infections showed inconsistent associations with in-hospital delay, further supporting risk-stratified rather than universal timing protocols. Conclusion: This systematic review demonstrates that the impact of surgical waiting time on appendiceal perforation is critically dependent on the temporal phase examined and patient-specific risk factors. Pre-hospital delay is a robust predictor of perforation, whereas in-hospital delay up to 24 hours is acceptable for low-risk adults with uncomplicated appendicitis. However, pediatric patients, elderly individuals, and those with appendicoliths or severe inflammatory markers require expedited surgery within 12 hours of presentation. We recommend implementation of risk-stratified triage protocols incorporating clinical, laboratory, and radiological parameters to optimize surgical timing. Future research should focus on prospective validation of composite risk stratification models and investigation of antibiotic therapy optimization during waiting periods. Healthcare institutions should prioritize public education to reduce pre-hospital delay while allocating resources for timely surgical intervention in high-risk populations.

A Comprehensive Systematic Review of Relationship Between Hba1c Levels and The Risk of Diabetic Retinopathy Ayusti Mutazila; Muhamad Ridho
The International Journal of Medical Science and Health Research Vol. 32 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/ntxxc419

Introduction: Diabetic retinopathy (DR) remains a leading cause of preventable blindness worldwide, with glycemic control identified as a critical modifiable risk factor. Despite extensive research, evidence gaps persist regarding optimal HbA1c thresholds, the role of glycemic variability, and the consistency of the HbA1c-DR relationship across diverse populations. This systematic review aims to comprehensively synthesize global evidence on the association between HbA1c levels and DR risk, severity, and progression. Methods: A systematic review was conducted following PRISMA guidelines. We screened studies based on predefined criteria including diabetes population, HbA1c measurement, DR outcome assessment, and study design. Data extraction encompassed study characteristics, HbA1c measurement methodology, DR assessment methods, association measures, moderating factors, and statistical approaches. The review synthesized evidence from 200 included studies encompassing diverse geographic regions and both Type 1 and Type 2 diabetes populations. Results: A strong, consistent positive association between elevated HbA1c and DR risk was demonstrated across all study designs and populations. Quantitative synthesis revealed that a 10% relative reduction in HbA1c decreases retinopathy progression risk by 43-45%, and each 1% absolute HbA1c reduction confers approximately 35% risk reduction. Mean HbA1c levels were consistently higher in DR patients versus those without (range: 8.09-9.50% vs. 7.21-8.49%). A dose-response relationship was evident, with progressive HbA1c elevation correlating with increasing DR severity. Threshold effects were identified at 7.0%, with substantially accelerated risk above 8.6%. HbA1c variability emerged as an independent predictor. Diabetes duration, hypertension, and dyslipidemia significantly moderated the relationship. Conclusion: This review establishes HbA1c as a dominant, modifiable, dose-dependent risk factor for diabetic retinopathy across all diabetes types and populations. No absolute safe threshold exists; risk reduction follows HbA1c improvement continuously. We recommend intensive, early glycemic control targeting individualized HbA1c goals, integrated multifactorial risk management, and incorporation of HbA1c variability into risk stratification. Future research should focus on establishing population-specific thresholds and investigating HbA1c variability intervention strategies.

The Comprehensive Systematic Review of Impact of Early Mobilization on Long-term Outcomes in ICU Patients Mohamad Fadli; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 32 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/7xkp5b59

Introduction: Early mobilization in intensive care unit (ICU) patients has been proposed to mitigate the deleterious effects of critical illness, yet its impact on long-term outcomes remains uncertain. This systematic review comprehensively evaluates the effects of early mobilization on long-term functional, cognitive, quality of life, and healthcare utilization outcomes in adult ICU patients. Methods: A systematic review was conducted following PRISMA guidelines. We included randomized controlled trials, controlled clinical trials, cohort studies, case-control studies, systematic reviews, and meta-analyses involving adult ICU patients (≥18 years) who received early mobilization (initiated within 72 hours of ICU admission or mechanical ventilation) compared to standard care or delayed mobilization. Long-term outcomes were defined as those measured at least 30 days post-ICU or hospital discharge. Data were extracted on patient characteristics, mobilization protocols, long-term outcomes, safety, and study quality. Results: Sixty-eight studies were included, comprising over 30,000 patients. Early mobilization consistently improved short-term functional outcomes, including muscle strength (mean difference 4.47-8.62 points on MRC scale), reduced ICU-acquired weakness (OR 2.04-2.7 for independent functional status), and increased likelihood of walking independently at discharge (OR 2.13) (Patel et al., 2023; Tipping et al., 2017; Hu et al., 2019). However, large randomized controlled trials found no significant improvement in long-term mortality (Hodgson et al., 2022) or quality of life at 6-12 months (Higgins et al., 2025). Notably, one trial demonstrated reduced cognitive impairment at 1 year (24% vs 43%, p=0.0043) (Patel et al., 2023). Subgroup analyses revealed potential harm in diabetic patients receiving high-intensity mobilization (adjusted OR 3.47 for 180-day mortality) (Serpa Neto et al., 2024). Adverse event rates were low (<3%), though the TEAM trial reported more events in the intervention group (9.2% vs 4.1%, p=0.005) (Hodgson et al., 2022). Discussion: The evidence presents a complex picture where early mobilization yields clear short-term functional benefits that do not consistently translate into improved long-term survival or quality of life. Heterogeneity in protocols, patient populations, and outcome measures limits definitive conclusions. Conclusion: Early mobilization safely improves in-hospital functional outcomes and reduces healthcare utilization. However, long-term benefits beyond hospital discharge remain unproven, and high-intensity protocols may harm specific subgroups. Individualized, progressive mobilization strategies are recommended.

A Comprehensive Systematic Review of The Role of Vasopressors in Early Management of Hemorrhagic Shock Mohamad Fadli; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 32 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/wf2brc56

Introduction: The role of vasopressors in the early management of hemorrhagic shock remains controversial, with conflicting evidence from observational studies and randomized controlled trials. This systematic review aims to evaluate the efficacy and safety of early vasopressor administration in adult patients with hemorrhagic shock. Methods: A systematic review was conducted screening studies based on predefined criteria: adult patients with hemorrhagic shock from any cause, evaluation of any vasopressor agent within the first 24 hours, comparative study designs reporting clinically relevant outcomes. Fifty-eight sources were identified including randomized controlled trials, observational studies, and systematic reviews. Data were extracted on patient populations, vasopressor interventions, mortality outcomes, hemodynamic effects, fluid requirements, and adverse events. Results: Randomized controlled trials demonstrated that low-dose norepinephrine (<0.3 µg/kg/min) concurrent with fluid resuscitation significantly reduced 24-hour mortality (3% vs 13%, p<0.05) and in-hospital mortality (9% vs 21%, p<0.05) (Mohamed et al., 2024). The AVERT-Shock trial found no mortality difference with low-dose vasopressin but showed reduced blood product requirements (1.4 L vs 2.9 L, p=0.01) (Sims et al., 2019). Observational studies consistently associated vasopressor use with increased mortality (Aoki et al., 2018; Plurad et al., 2011; Fisher et al., 2020), though propensity-score analyses attenuated this association (Gauss et al., 2018). Vasopressors consistently achieved hemodynamic stabilization with improved mean arterial pressure and reduced fluid requirements. Adverse event profiles were similar between groups, with vasopressin associated with fewer deep venous thromboses (Sims et al., 2019). Discussion: The apparent contradiction between observational and randomized evidence is explained by confounding by indication, where sicker patients preferentially receive vasopressors. Context-dependent effects, agent-specific considerations, and timing of administration significantly influence outcomes. Low-dose vasopressors appear safe when used as adjuncts to—not replacements for—hemorrhage control and volume resuscitation. Conclusion: Early low-dose vasopressor administration, particularly norepinephrine and vasopressin, may be beneficial in selected patients with hemorrhagic shock, improving hemodynamic stability and reducing transfusion requirements without increasing mortality. Further research is needed to optimize agent selection, dosing strategies, and timing of initiation.

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Indra Hadi

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profesionaljournalmedicine@gmail.com

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Journal Mail Official
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Editorial Address
Equity Tower. 49th Floor. Sudirman Street. Special Region of Jakarta, Indonesia

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Kota adm. jakarta selatan,

Dki jakarta

INDONESIA