Low-dose vasopressin in the treatment of septic shock in sheep.
After induction of cecal perforation, 20 anesthetized sheep were randomized to be treated, when arterial blood pressure fell below 75 mm Hg, with vasopressin (fixed dose of 0.02 U/minute), norepinephrine (0.5-5 microg/kg/minute titrated to maintain mean arterial pressure between 75 and 85 mm Hg), vasopressin + norepinephrine (vasopressin at fixed dose 0.01 U/minute plus norepinephrine titrated as for norepinephrine only group), or no vasopressor (Ringer's lactate [control]). Mean arterial pressure was well maintained in all treatment groups. Superior mesenteric arterial blood flow was significantly lower in the vasopressin + norepinephrine group than in the vasopressin group. Vasopressin alone or combined with norepinephrine limited the increase in blood lactate concentration and ileal PCO2-gap compared with control and norepinephrine groups. Urine output was higher in the vasopressin group than in control and norepinephrine groups. Survival time was longer in the vasopressin (30 +/- 6 hours) and vasopressin + norepinephrine (30 +/- 3 hours) groups than in the norepinephrine group (20 +/- 1 hours, p < 0.05) and in all treatment groups than in the control group (17 +/- 2 hours, p < 0.05). Tissue injury was less severe in the vasopressin and vasopressin + norepinephrine groups than in the others. In this clinically relevant model of septic shock due to peritonitis, vasopressin administration (alone or with norepinephrine) can prolong survival.
Sun
Qinghua
Q
Ph.D. Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, B-1070 Brussels, Belgium.
Dimopoulos
George
G
Nguyen
Duc Nam
DN
Tu
Zizhi
Z
Nagy
Nathalie
N
Hoang
Anh Dung
AD
Rogiers
Peter
P
De Backer
Daniel
D
Vincent
Jean-Louis
JL
D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D002245:Carbon Dioxide / Q000097:blood; D002432:Cecum / Q000293:injuries; D007082:Ileum / Q000098:blood supply; D007416:Intestinal Perforation / Q000150:complications; D007552:Isotonic Solutions; D007773:Lactates / Q000097:blood; D008638:Mesenteric Arteries / Q000187:drug effects; D009638:Norepinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011897:Random Allocation; D000077325:Ringer's Lactate; D012756:Sheep; D012772:Shock, Septic / Q000188:drug therapy* / Q000652:urine; D013152:Splanchnic Circulation / Q000187:drug effects; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D014667:Vasopressins / Q000008:administration & dosage / Q000627:therapeutic use*
D007552:Isotonic Solutions; D007773:Lactates; D000077325:Ringer's Lactate; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D002245:Carbon Dioxide; D009638:Norepinephrine