Comparison of first-line and second-line terlipressin versus sole norepinephrine in fulminant ovine septic shock

Abstract

The Surviving Sepsis Guidelines suggest the use of vasopressin in case of catecholamine-refractory septic shock. Terlipressin (TP) as a V1-selective AVP analogue is a potential alternative, though data regarding the first-line administration in septic shock are scarce. The present study explored and compared the effects of first-line vs. second-line infusion of TP or sole norepinephrine regarding organ function, fluid and norepinephrine requirements and survival in fulminant ovine septic shock. Peritoneal sepsis was induced in 23 ewes after laparotomy and faecal withdrawal from the caecum. After onset of shock, causal and supportive sepsis therapy (antibiotics, peritoneal lavage, fluids and open-label norepinephrine) was performed in all animals. Concurrently, animals were randomized to receive 0.9% sodium chloride (control group) or TP (2 µg∙kg−1∙h−1, first-line group) after shock onset. In the second-line TP group, TP (2 µg∙kg−1∙h−1) was started once norepinephrine requirements exceeded 0.5 µg∙kg−1∙min−1. No significant differences were found between groups regarding survival, haemodynamics as well as fluid- and catecholamine-requirements. Kidney function and electron microscopic kidney injury were comparable between groups. In the present model of fulminant ovine septic shock, first-line TP infusion had no significant effect on fluid and norepinephrine requirements or organ dysfunction as compared to second-line TP infusion or placebo.

Effects of Collagen Antibacterial Functional Dressing plus Continuous Nursing on Lower Extremity Skin Injury Caused by Norepinephrine in Patients with Septic Shock

“…To this end, comprehensive nursing has been identified for complication prevention of the lower extremities to potentiate the efficacy of norepinephrine; nonetheless, the expected treatment outcome is somehow compromised [ 8 , 9 ]. Previous studies have found that in the treatment of the skin radiation injury of breast cancer patients during radiotherapy [ 10 , 11 ], the collagen antibacterial functional dressing accelerated cell metabolism, promoted wound healing, relieved skin pain, and regulated the level of local inflammatory factors, which is conducive to injured skin repair. Accordingly, this study was designed to explore the effectiveness of collagen antibacterial functional dressing plus continuous care on the skin injury of lower extremities caused by norepinephrine in patients with septic shock.…”

Terlipressin Versus Norepinephrine for Septic Shock: A Systematic Review and Meta-Analysis

“…First is due to the small sample size that limited the precision of the overall review. Second, we didn't conduct a subgroup meta-analysis based on the different timing of TP usage, since there were only some studies performed on animals (Asfar et al, 2005;Kampmeier et al, 2018) and case series (Zeballos et al, 2006;Morelli et al, 2007).…”