Background:
The swift administration of vasoactive agents is essential for effectively managing septic shock. However, the unavailability of norepinephrine—the primary recommended agent—in certain clinical settings necessitates the exploration of alternative solutions. This study aimed to identify both the key focus areas and the under-researched aspects related to this topic.
Methods:
The Scopus database was searched from inception until August 2, 2024, using a comprehensive list of keywords related to the topics of “septic shock”, “vasopressors”, and “hypotension”. Articles lacking original data, namely narrative reviews, errata, corrections, and conference papers, were excluded from the analysis. No language restrictions were applied. The retrieved search results were examined for publication and citation trends, international contributions by countries and institutions, keyword usage, and funding sources. Data visualization was accomplished using VOSviewer, the built-in Scopus analyzer, the bibliometrix R package, and Microsoft Excel.
Results:
A total of 7474 publications were retrieved. These studies were published between 1958 and 2024, with the year 2022 representing the highest number of publications, and 2016 having the most citations. While publications had raised until 2022 and dwindled since then, citations had fluctuating patterns throughout the years. The research landscape was marked by contributions from 207 countries, with 160 institutions publishing at least 22 studies each. The United States emerged as the leader in both publications and international collaborations in this field, followed by France, the United Kingdom, China, and Germany. Notably, all of the top 20 countries in terms of publication volume were classified as high-income or upper-middle-income nations, except India. This disparity can largely be explained by the differences in funding allocated to studies in these countries. Furthermore, 28,442 keywords relevant to this topic were collected. The demographic representation in the studies showed a predominance of males and older adults compared to their counterparts and a significant proportion of the studies were clinical investigations. Among the various vasopressors examined, terlipressin, angiotensin II, methylene blue, and selepressin were identified as the least studied agents.
Conclusion:
Consensus definitions and statements in critical care, particularly for controversial topics, are essential for enhancing communication and improving patient care. There is a need for prioritized research and funding in the Global South regarding enhanced septic shock management. Further studies on vasoconstrictor agents with limited evidence are warranted to strengthen the body of knowledge in this area.
