Hemodynamic Characteristics of Vasopressin in Dogs with Severe Hemorrhagic Shock

Abstract

ABSTRACT. The effect of vasopressin was compared with that of the established vasopressor epinephrine in experimentally induced hemorrhagic shock. After rapid crystalloid resuscitation in a ratio of three volumes of 0.9% saline to one volume of blood (3:1 crystalloid resuscitation), six dogs were given 0.4 IU/kg vasopressin and another six dogs were given 0.1 mg/kg epinephrine. Five dogs in the control group were given fluid resuscitation in the same manner as above without administration of any drugs. Administration of vasopressin increased diastolic arterial pressure (DAP) from 45.0 ± 4.9 to 91.2 ± 9.6 mmHg within 5 min, compared with epinephrine from 46 ± 4.0 to 51.8 ± 7.7, and control from 47.3 ± 7.5 to 46.3 ± 7.3. Systolic arterial pressure (SAP) did not increase significantly following vasopressin compared with epinephrine and control group. Results of DAP and systemic vascular resistance index (SVRI) suggested that vasopressin administration was vasoconstrictive after fluid resuscitation in decompensatory hemorrhagic shock in dogs, whereas epinephrine did not compared with control. In addition, epinephrine did not affect the cardiac index (CI) and SVRI, while a significant decrease in CI and increase in SVRI were observed in vasopressin group. The pressor effect of epinephrine in the vascular system was abrupt and only lasted a short period of time (within 5 min), while that of vasopressin was steady and lasted for more than 1 hr, especially regard to in DAP. When compared with epinephrine, vasopressin can be a more effective and safer choice in patients with severe hemorrhagic shock. KEY WORDS: canine, epinephrine, hemodynamics, hemorrhagic shock, vasopressin.J. Vet. Med. Sci. 68(9): 967-972, 2006 In the late phase of hemorrhagic shock, the compensation mechanism fails to recover blood flow and global tissue perfusion is severely compromised. Cardiovascular support drugs are indicated for the cases where aggressive intravascular volume resuscitation has not been sufficient to increase cardiac output (CO), blood pressure, and oxygen use [17]. Positive inotropic drugs, such as dobutamine, dopamine [16], and epinephrine [14] increase stroke volume and cardiac output. Dopamine and epinephrine also possess vasopressor action. However, the use of catecholamine has some disadvantages, including increasing myocardial oxygen demand more than delivery, predisposing the myocardium to arrhythmias, and producing lactic acidosis [20].Vasopressin has been identified as a treatment that effectively restores circulation in the late phase of hemorrhagic shock in cases unresponsive to blood replacement and catecholamines in dogs [15]. Moreover, vasopressin enabled short-and long-term survival in a porcine model of uncontrolled hemorrhagic shock after penetrating liver trauma [23,24] and has been successfully used in a small number of patients with intra-abdominal bleeding and subsequent shock that was unresponsive to volume replacement [23]. Despite reports of successful resuscitation with vasopressin, vasopressin has n...

Laceración iatrogénica de la aorta abdominal en un perro

“…A conduta emergencial indicada em casos de hemorragia intra-abdominal, como a oxigenoterapia, aplicação da bandagem compressiva e em alguns casos a transfusão sanguínea, podem estabilizar o paciente ao ponto de não ser necessário a intervenção cirúrgica (Fossum T. W., 2014). O uso de drogas vasoativas e inotrópicas positivas, como vasopressina e epinefrina, também é indicado em casos em que o restabelecimento do volume intravascular não é o suficiente para recuperar a pressão arterial e o débito cardíaco (Yoo et al, 2006). Entretanto, nesse caso, mesmo com a abordagem emergencial e o uso de drogas vasoativas e inotrópicas positivas, não foi possível estabilizar o paciente, tornando-se imprescindível a intervenção cirúrgica.…”

The use of vasopressin for treating vasodilatory shock and cardiopulmonary arrest

“…Significant increases in MAP via V 1 systemic receptor stimulation have been observed in porcine 30–33 and ovine 4,34–36 endotoxic shock models. The use of AVP in 2 studies of canine hemorrhagic shock also resulted in a marked increase in MAP 7,37 . A recent case series of dopamine resistant hypotension and vasodilatory shock in dogs showed an increase in MAP after AVP (0.5–1.25 mU/kg/min) constant rate infusion 38 .…”

“…It is believed that AVP at low doses (0.01–0.04 U/min) does not cause preferential vasoconstriction to any organ but at high does becomes markedly selective 21 . In studies that measured vascular resistance a significant increase was noted with the use of V 1 agonists 4,30,37,39 . In addition to improved hemodynamic parameters, improved survival was observed with the use of low‐dose V 1 agonists in endotoxic rats 29 …”

Vasopressin for Hemorrhagic Shock Management: Revisiting the Potential Value in Civilian and Combat Casualty Care

“…Finally, the AVP effect lasted for almost 1 hour when compared with epinephrine, which diminished after 5 minutes. 5,34,35 AVP also leads to a better outcome during cardiopulmonary resuscitation (CPR) for hypovolemic cardiac arrest. Although a spontaneous circulation was also achieved with epinephrine, all the animals in the catecholamine group died within the first hour after successful resuscitation.…”