The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series.
OBJECTIVE
To review all cases of septic shock treated with vasopressin to determine the effects on hemodynamic and renal function and to document any adverse effects.


METHODS
A 14-bed mixed medical-surgical ICU of St. Paul's Hospital, a 450-bed tertiary referral hospital affiliated with the University of British Columbia.


METHODS
All ICU patients who received vasopressin for treatment of severe septic shock between August 5, 1997, and March 21, 1999.


RESULTS
We identified 50 patients: age 60 (+/-14); APACHE II score 27 (+/-7). Baseline data (T0) was compared to data at T4, T24 and T48 (4, 24 and 48 h) on infusion. Mean arterial pressure (MAP) increased by 18% from T0 to T4 and remained stable at T24 (p=0.006) and T48 (p=0.008). Systolic pulmonary artery pressure (PAP) was unchanged at 45+/-13 mmHg. Mean cardiac index (CI) decreased by 11% at T4 (p=0.03). Urine output increased 79% at T4 (p=0.005) and further increases were not significant at T24 and T48. Mean pressor dosage decreased by 33% at T4 (p=0.001), by 53% at T24 (p=0.002) and by 48% at T48 (p=0.01). Hospital mortality was 85%. There were six cardiac arrests; all but one occurred at a vasopressin dose of 0.05 U/min or more.


CONCLUSIONS
In this group of patients with severe septic shock, vasopressin infusion increased MAP and urine output and decreased catecholamine requirements. Doses higher than 0.04 U/min were not associated with increased effectiveness and may have been associated with higher adverse effects.
Holmes
C L
CL
Program of Critical Care Medicine, University of British Columbia, Department of Medicine, Room 545 Burrard Building, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
Walley
K R
KR
Chittock
D R
DR
Lehman
T
T
Russell
J A
JA
D000704:Analysis of Variance; D004305:Dose-Response Relationship, Drug; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000494:pharmacology*; D014667:Vasopressins / Q000009:adverse effects / Q000494:pharmacology*
D014662:Vasoconstrictor Agents; D014667:Vasopressins