Effects of Continuous Vasopressin Infusion in Patients with Septic Shock

Abstract

Vasopressin infusion was effective in increasing MAP and reducing heart rate while decreasing the dopamine dosage in patients with septic shock. Comparative studies with catecholamine vasopressors are needed to define the optimal role of vasopressin in septic shock therapy. In the meantime, vasopressin infusion at <or=0.03 units/min should be considered only if response to 1 or 2 catecholamine vasopressors is inadequate or as a method to reduce the dose of these therapies.

Addition of Vasopressin to Norepinephrine as Independent Predictor of Mortality in Patients with Refractory Septic Shock: An Observational Study

“…Four hours after the additional vasopressors were added, the norepinephrine dose was significantly lower than the baseline value in patients randomized to vasopressin, with no statistically significantly change observed in the norepinephrine-only group. Similar dose-reducing effects have been observed when vasopressin is added to dopamine infusions [22]. Interestingly, the opposite effect was seen in our study in that patients who received vasopressin plus norepinephrine had statistically higher mean cardiovascular SOFA scores and thus a higher norepinephrine dose requirement over the first seven days of vasopressor therapy.…”

“…During the early phases of septic shock, circulating vasopressin concentrations are elevated, but as hypotension persists, these concentrations decrease, and neurohypophyseal and plasma concentrations become deficient [13,[15][16][17]. Vasopressin deficiency is one of the mechanisms involved in the development of vasodilatory shock [8], which has led to various studies showing that exogenous vasopressin increases the MAP while reducing the necessary norepinephrine dosage, and that it may improve urine output [18][19][20][21][22]. However, there may be negative consequences associated with administration of vasopressin to patients with septic shock, including myocardial and splanchnic ischemia [19].…”

“…fects [19,20,29], administration of this agent to patients requiring low-dose norepinephrine has been reported [22] and tested at many medical centers. The best example of the catecholamine-sparing effect was demonstrated in a randomized, double-blind study conducted by Patel et al [21], in which patients requiring norepinephrine for septic shock were randomized to additional norepinephrine or vasopressin in doses up to 0.08 units/min.…”

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

“…Rationale: Observational trends from a large, multicenter, double-blinded randomized controlled trial and a large, multicenter, observational cohort study report the addition of a second vasopressor agent in up to 26% 18 and 54% 22 of cases in all shock types. If other treatment principles are being addressed and the mean arterial pressure goal is still not being met, then the addition of a second vasopressor may be required.…”

Hepatorenal Syndrome

“…The mean vasopressin dose in patients that responded to therapy was 0.23 ± 0.19 units/min, which is significantly higher than typically utilized in shock syndromes [26]. Although patients with cirrhosis and HRS appear to be more tolerant to higher doses of vasopressin, caution and careful monitoring of serum lactate levels and the monitoring of extremities for ischemia should be maintained for patients receiving vasopressin doses >0.1 units/min as adverse effects related to vasopressin are ischemic in nature and dose dependent [27].…”