The Cardiopulmonary Effects of Vasopressin Compared With Norepinephrine in Septic Shock

Gordon, Anthony; Wang, Nan; Walley, Keith R.; Ashby, Deborah; Russell, James A.

doi:10.1378/chest.11-2604

Cited by 73 publications

(58 citation statements)

References 29 publications

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“…30 Similarly, there was a higher rate of tachyarrhythmia among patients in the levosimendan group than among those in the placebo group. These observations may have contributed to the lack of overall clinical benefit and are consistent with recent data that suggest a potential benefit in treating persistent tachycardia in patients with sepsis with the use of beta-blockers.…”

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confidence: 92%

Levosimendan for the Prevention of Acute Organ Dysfunction in Sepsis

et al. 2016

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BACKGROUNDLevosimendan is a calcium-sensitizing drug with inotropic and other properties that may improve outcomes in patients with sepsis. METHODSWe conducted a double-blind, randomized clinical trial to investigate whether levosimendan reduces the severity of organ dysfunction in adults with sepsis. Patients were randomly assigned to receive a blinded infusion of levosimendan (at a dose of 0.05 to 0.2 μg per kilogram of body weight per minute) for 24 hours or placebo in addition to standard care. The primary outcome was the mean daily Sequential Organ Failure Assessment (SOFA) score in the intensive care unit up to day 28 (scores for each of five systems range from 0 to 4, with higher scores indicating more severe dysfunction; maximum score, 20). Secondary outcomes included 28-day mortality, time to weaning from mechanical ventilation, and adverse events. RESULTSThe trial recruited 516 patients; 259 were assigned to receive levosimendan and 257 to receive placebo. There was no significant difference in the mean (±SD) SOFA score between the levosimendan group and the placebo group (6.68±3.96 vs. 6.06±3.89; mean difference, 0.61; 95% confidence interval [CI], −0.07 to 1.29; P = 0.053). Mortality at 28 days was 34.5% in the levosimendan group and 30.9% in the placebo group (absolute difference, 3.6 percentage points; 95% CI, −4.5 to 11.7; P = 0.43). Among patients requiring ventilation at baseline, those in the levosimendan group were less likely than those in the placebo group to be successfully weaned from mechanical ventilation over the period of 28 days (hazard ratio, 0.77; 95% CI, 0.60 to 0.97; P = 0.03). More patients in the levosimendan group than in the placebo group had supraventricular tachyarrhythmia (3.1% vs. 0.4%; absolute difference, 2.7 percentage points; 95% CI, 0.1 to 5.3; P = 0.04). CONCLUSIONSThe addition of levosimendan to standard treatment in adults with sepsis was not associated with less severe organ dysfunction or lower mortality. Levosimendan was associated with a lower likelihood of successful weaning from mechanical ventilation and a higher risk of supraventricular tachyarrhythmia. (Funded by the NIHR Efficacy and Mechanism Evaluation Programme and others; LeoPARDS Current Controlled Trials number, ISRCTN12776039.)A BS TR AC T

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Levosimendan for the Prevention of Acute Organ Dysfunction in Sepsis

et al. 2016

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“…The potential survival benefit of vasopressin in less severely shocked patients was also seen in those patients who had the lowest lactate levels [5]. The haemodynamic effects of both noradrenaline and vasopressin were similar, with no difference in cardiac or stroke volume index between the two treatment groups, although there was a greater use of inotropes in the vasopressin group [6]. Vasopressin use was associated with a significant reduction in heart rate particularly in the less severe shock subgroup, potentially due to reduced catecholamine use.…”

Section: Vasopressin In Septic Shockmentioning

confidence: 89%

What’s new in vasopressin?

O’Callaghan

Gordon

2015

Intensive Care Med

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Vasopressin in septic shockSeptic shock is associated with a relative deficiency of the endogenous stress hormone vasopressin. In shock states vasopressin binds to vasopressin receptors on vascular smooth muscle, producing intense vasoconstriction with minimal osmotic effects and resulting in increased blood pressure. Two recent meta-analyses report relative risks (RR) of short-term mortality in favour of vasopressin analogues compared to noradrenaline; however, using different methodologies, one group found this difference to be statistically significant (RR = 0.87, 95 % CI 0.77-0.99) [1] and the other did not (RR = 0.91, 95 % CI 0.79-1.

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“…Interestingly, in the VASST trial 7 a reduction in HR in the subgroup with less severe septic shock was found in the treatment group (vasopressin) and was associated with a reduction in mortality, supporting the idea that avoidance of tachycardia and blunting catecholamine over-stimulation could be beneficial in septic patients.…”

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confidence: 85%

Sepsis and beta-blockade: a look into diastolic function

Astuto

2015

Current Medical Research and Opinion

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The Cardiopulmonary Effects of Vasopressin Compared With Norepinephrine in Septic Shock

Cited by 73 publications

References 29 publications

Levosimendan for the Prevention of Acute Organ Dysfunction in Sepsis

Levosimendan for the Prevention of Acute Organ Dysfunction in Sepsis

What’s new in vasopressin?

Sepsis and beta-blockade: a look into diastolic function

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