Management of vasodilatory shock: defining the role of arginine vasopressin.
The rationale for an arginine vasopressin (argipressin) infusion was put forward after it was discovered that patients in shock states might have an endogenous arginine vasopressin deficiency. Subsequently, several investigations impressively demonstrated that arginine vasopressin can successfully stabilise haemodynamics even in advanced vasodilatory shock. We report on physiological and pharmacological aspects of arginine vasopressin, and summarise current clinical knowledge on employing a continuous arginine vasopressin infusion in critically ill patients with catecholamine-resistant vasodilatory shock of different aetiologies. In view of presented experimental evidence and current clinical experience, a continuous arginine vasopressin infusion of approximately 2 to approximately 6 IU/h can be considered as a supplemental strategy to vasopressor catecholamines in order to preserve cardiocirculatory homeostasis in patients with advanced vasodilatory shock. Because data on adverse effects are still limited, arginine vasopressin should be reserved for patients in whom adequate haemodynamic stabilisation cannot be achieved with conventional vasopressor therapy or who have obvious adverse effects of catecholamines that result in further significant haemodynamic deterioration. For the same reasons, arginine vasopressin should not be used as a single, alternative vasopressor agent instead of catecholamine vasopressors. Future prospective studies will be necessary to define the exact role of arginine vasopressin in the therapy of vasodilatory shock.
Dunser
Martin W
MW
Division of General and Surgical Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria.
Wenzel
Volker
V
Mayr
Andreas J
AJ
Hasibeder
Walter R
WR
D001127:Arginine Vasopressin / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D002395:Catecholamines / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004351:Drug Resistance; D006801:Humans; D007262:Infusions, Intravenous; D012769:Shock / Q000188:drug therapy* / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D014664:Vasodilation
D002395:Catecholamines; D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin