Arginine vasopressin in advanced vasodilatory shock: a prospective, randomized, controlled study.
BACKGROUND
Vasodilatory shock is a potentially lethal complication of severe disease in critically ill patients. Currently, catecholamines are the most widely used vasopressor agents to support blood pressure, but loss of catecholamine pressor effects is a well-known clinical dilemma. Arginine vasopressin (AVP) has recently been shown to be a potent vasopressor agent to stabilize cardiocirculatory function even in patients with catecholamine-resistant vasodilatory shock.


RESULTS
Forty-eight patients with catecholamine-resistant vasodilatory shock were prospectively randomized to receive a combined infusion of AVP and norepinephrine (NE) or NE infusion alone. In AVP patients, AVP was infused at a constant rate of 4 U/h. Hemodynamic, acid/base, single-organ, and tonometrically derived gastric variables were reported before the study and 1, 12, 24, and 48 hours after study entry. For statistical analysis, a mixed-effects model was used. AVP patients had significantly lower heart rate, NE requirements, and incidence of new-onset tachyarrhythmias than NE patients. Mean arterial pressure, cardiac index, stroke volume index, and left ventricular stroke work index were significantly higher in AVP patients. NE patients developed significantly more new-onset tachyarrhythmias than AVP patients (54.3% versus 8.3%). Gastrointestinal perfusion as assessed by gastric tonometry was better preserved in AVP-treated patients. Total bilirubin concentrations were significantly higher in AVP patients.


CONCLUSIONS
The combined infusion of AVP and NE proved to be superior to infusion of NE alone in the treatment of cardiocirculatory failure in catecholamine-resistant vasodilatory shock.
Division of General and Surgical Intensive Care Medicine, Department of Anesthesia and Critical Care Medicine, The Leopold Franzens University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Martin W
MW
Dünser
Andreas J
AJ
Mayr
Hanno
H
Ulmer
Hans
H
Knotzer
Günther
G
Sumann
Werner
W
Pajk
Barbara
B
Friesenecker
Walter R
WR
Hasibeder
D000368:Aged; D001127:Arginine Vasopressin / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004359:Drug Therapy, Combination; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D009638:Norepinephrine / Q000627:therapeutic use; D012769:Shock / Q000175:diagnosis / Q000188:drug therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014664:Vasodilation
D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin; D009638:Norepinephrine