Haemodynamic Effects of Early Vasopressin Infusion During Septic Shock

Garcia, Roberto; Franco, Juvenal; Aguirre, Janet S; Martínez, José Joaquín Alfaro

doi:10.1097/00003246-200212001-00363

Cited by 3 publications

(10 citation statements)

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“…9,32 These effects occurred rapidly and were maintained for the study duration. Vasopressin therapy was associated with an increased SVR or SVR index 9, 17 ; a decrease in or no effect on heart rate, cardiac output, or cardiac index 9,17,32 ; and enhanced urine production in patients not anuric when vasopressin was started. 17 No adverse events were reported.…”

Section: Prospective Cohort Trialsmentioning

confidence: 90%

“…In six prospective cohort studies, vasopressin was evaluated in patients with septic shock (Table 2). 9,17,[31][32][33][34] None of these studies included a comparison group. In four studies, vasopressin was administered at 0.04 U/minute for 1-24 hours to patients requiring adrenergic agents.…”

Section: Prospective Cohort Trialsmentioning

confidence: 99%

“…9,17,31,32 In one of these, the authors investigated the early administration of vasopressin shortly after norepinephrine was started for initial therapy of septic shock, 31 whereas in the other three studies vasopressin was started after at least 1 day of therapy with adrenergic agonists 9 or in patients requiring norepinephrine 0.2 µg/kg/minute or greater. 17,32 In the remaining two studies, the dosage of vasopressin was allowed to be adjusted according to blood pressure in an effort to reduce or discontinue the administration of high-dose norepinephrine. 33,34 In the early-administration study, vasopressin was started at 0.04 U/minute when the norepinephrine dosage reached 5 µg/minute in 16 patients with septic shock.…”

Section: Prospective Cohort Trialsmentioning

confidence: 99%

“…The other three studies included 32 total patients, and vasopressin was infused at 0.04 U/minute for 1-16 hours. 9,17,32 The results of these studies showed that starting vasopressin in patients with septic shock who required adrenergic agents significantly improved SAP, diastolic arterial pressure, and MAP, while discontinuing or reducing the dosages of adrenergic agents. 9,32 These effects occurred rapidly and were maintained for the study duration.…”

Section: Prospective Cohort Trialsmentioning

confidence: 99%

“…9,17,32 The results of these studies showed that starting vasopressin in patients with septic shock who required adrenergic agents significantly improved SAP, diastolic arterial pressure, and MAP, while discontinuing or reducing the dosages of adrenergic agents. 9,32 These effects occurred rapidly and were maintained for the study duration. Vasopressin therapy was associated with an increased SVR or SVR index 9, 17 ; a decrease in or no effect on heart rate, cardiac output, or cardiac index 9,17,32 ; and enhanced urine production in patients not anuric when vasopressin was started.…”

Section: Prospective Cohort Trialsmentioning

confidence: 99%

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The Role of Vasopressin in Vasodilatory Septic Shock

et al. 2004

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Septic shock that requires therapy with adrenergic agents is associated with high rates of mortality. Inappropriately normal or low serum concentrations of vasopressin contribute to the development of hypotension during sepsis. We critically evaluated the role of administering exogenous vasopressin to patients with septic shock. A computerized search of MEDLINE from January 1966--December 2003 and a manual search of relevant journals for abstracts were conducted. Eleven retrospective, six prospective cohort, and four prospective randomized studies were identified. Most studies evaluated short-term infusions of vasopressin at 0.08 U/minute or less as add-on therapy in patients requiring adrenergic agents. The results show that starting vasopressin in patients with septic shock increases systemic vascular resistance and arterial blood pressure, thus reducing the dosage requirements of adrenergic agents. These effects are rapid and sustained. Substantial enhancement of urine production, likely due to increased glomerular filtration rate, was shown in several studies. A few studies demonstrated clinically significant reduced cardiac output or cardiac index after vasopressin was begun, necessitating cautious use in patients with cardiac dysfunction. Vasopressin was associated with ischemia of the mesenteric mucosa, skin, and myocardium; elevated hepatic transaminase and bilirubin concentrations; hyponatremia; and thrombocytopenia. Limiting the dosage to 0.03 U/minut or less may minimize the development of these adverse effects. Vasopressin 0.03 U/minute or less should be considered if response to one or two adrenergic agents is inadequate or as a method to reduce the dosage of adrenergic agents. At present, vasopressin therapy should not be started as first-line therapy. Additional studies are needed to determine the optimum dosage, duration, and place in therapy of vasopressin relative to adrenergic agents. A multicenter, comparative study of vasopressin 0.03 U/minute as add-on therapy is under way and should provide mortality data.

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Section: Prospective Cohort Trialsmentioning

confidence: 90%

Section: Prospective Cohort Trialsmentioning

confidence: 99%

Section: Prospective Cohort Trialsmentioning

confidence: 99%

Section: Prospective Cohort Trialsmentioning

confidence: 99%

Section: Prospective Cohort Trialsmentioning

confidence: 99%

See 3 more Smart Citations

The Role of Vasopressin in Vasodilatory Septic Shock

et al. 2004

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Effects of Continuous Vasopressin Infusion in Patients with Septic Shock

et al. 2004

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The safety and efficacy of the use of vasopressin in sepsis and septic shock

Wilson¹,

Mehta²,

Bellamy³

2005

Expert Opinion on Drug Safety

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Sepsis remains a significant problem and cause of morbidity and mortality in intensive care. Vasopressin infusions are currently used as rescue therapy for the treatment of vasodilatory, catecholamine-resistant septic shock. At present, there are no large randomised, controlled trials in the literature investigating vasopressin in this role, although two such studies are currently ongoing in Canada. This review outlines the pathophysiology of sepsis and that of vasopressin in sepsis and reviews the available evidence for the use of vasopressin in sepsis and septic shock. A review of the safety data for vasopressin in this indication is included. Recommendations for the use of vasopressin in septic shock, along with suggestions for the direction of further work in the field are presented.

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Haemodynamic Effects of Early Vasopressin Infusion During Septic Shock

Cited by 3 publications

References 0 publications

The Role of Vasopressin in Vasodilatory Septic Shock

The Role of Vasopressin in Vasodilatory Septic Shock

Effects of Continuous Vasopressin Infusion in Patients with Septic Shock

The safety and efficacy of the use of vasopressin in sepsis and septic shock

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