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

Abstract

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.

Sepsis-induced Cardiomyopathy

“…Vasopressin (AVP) and terlipressin are increasingly used as adjunct vasopressors in the treatment of catecholamine-resistant septic shock [212]. The deficit of vasopressin and downregulation of vasopressin receptors in severe sepsis and septic shock [213], would justify their use.…”

Massive Melena due to Arginine – Vasopressin for Septic Shock in Two Pediatric Patients

“…(4) used a maximum dosage of 0.004 U·kg −1 ·min −1 . Major side effects reported with AVP therapy include declining cardiac index values and bowel ischemia (1,5). However, there are limited reports of bowel ischemia and massive melena, when AVP dosages are within those used for septic shock.…”

Arginine-vasopressin in catecholamine-refractory septic versus non-septic shock in extremely low birth weight infants with acute renal injury

“…Major side effects of concern associated with AVP therapy are tissue hypoperfusion (mainly splanchnic) and a rebound phenomenon in vascular hyporeactivity with recurrent arterial hypotension [ 21 , 22 ]. No immediate side effects were seen in the surviving infants.…”