Beneficial effects of short-term vasopressin infusion during severe septic shock.
BACKGROUND
Septic shock is associated with vasopressin deficiency and a hypersensitivity to its exogenous administration. The goal of the current study was to determine whether short-term vasopressin infusion in patients experiencing severe septic shock has a vasopressor sparing effect while maintaining hemodynamic stability and adequate end-organ perfusion.


METHODS
Patients experiencing septic shock that required high-dose vasopressor support were randomized to a double-blinded 4-h infusion of either norepinephrine (n = 11) or vasopressin (n = 13), and open-label vasopressors were titrated to maintain blood pressure. To assess end-organ perfusion, urine output and creatinine clearance, gastric mucosal carbon dioxide tension, and electrocardiogram ST segment position were measured.


RESULTS
Patients randomized to norepinephrine went from a median prestudy norepinephrine infusion of 20.0 microg/min to a blinded infusion of 17.0 mug/min at 4 h, whereas those randomized to vasopressin went from a median prestudy norepinephrine infusion of 25.0 microg/min to 5.3 microg/min at 4 h (P < 0.001). Mean arterial pressure and cardiac index were maintained in both groups. Urine output did not change in the norepinephrine group (median, 25 to 15 ml/h) but increased substantially in the vasopressin group (median, 32.5 to 65 ml/h; P < 0.05). Similarly, creatinine clearance did not change in the norepinephrine group but increased by 75% in the vasopressin group (P < 0.05). Gastric mucosal carbon dioxide tension and electrocardiogram ST segments did not change significantly in either group.


CONCLUSIONS
The authors conclude that short-term vasopressin infusion spared conventional vasopressor use and improved some measures of renal function in patients with severe septic shock.
Patel
Bhavesh M
BM
Department of Critical Care, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
Chittock
Dean R
DR
Russell
James A
JA
Walley
Keith R
KR
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002245:Carbon Dioxide / Q000097:blood; D002302:Cardiac Output / Q000187:drug effects; D003404:Creatinine / Q000652:urine; D004311:Double-Blind Method; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009318:Natriuresis / Q000187:drug effects; D009638:Norepinephrine / Q000627:therapeutic use; D012039:Regional Blood Flow / Q000502:physiology; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology; D014563:Urodynamics / Q000502:physiology; D014655:Vascular Resistance / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000008:administration & dosage / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D014667:Vasopressins; D002245:Carbon Dioxide; D003404:Creatinine; D009638:Norepinephrine