The effect of vasopressin on gastric perfusion in catecholamine-dependent patients in septic shock.
OBJECTIVE
To study the effect of continuous infusion of vasopressin on the splanchnic circulation in patients with severe septic shock.


METHODS
Prospective clinical study.


METHODS
ICU in a teaching hospital.


METHODS
Eleven consecutive patients with documented septic shock who remained hypotensive despite norepinephrine infusion at a rate > or =0.2 microg/kg/min.


METHODS
Insertion of a gastric tonometry catheter, and continuous infusion of vasopressin 0.04 U/min during 4 h.


RESULTS
Difference between gastric and arterial CO(2) partial pressure (P[g-a]CO(2) gap), mean arterial pressure, and cardiac index were recorded at baseline and after 15 min, 30 min, 60 min, 120 min, and 240 min.


RESULTS
The median P(g-a)CO(2) gap increased from 5 mm Hg at baseline to 19 mm Hg after 4 h (p = 0.022). Mean arterial pressure increased from 61 +/- 13 mm Hg at baseline to 68 +/- 9 mm Hg after 4 h (p = 0.055). No significant changes in cardiac index were noted.


CONCLUSIONS
In norepinephrine-dependent patients in septic shock, continuous infusion of low-dose vasopressin results in a significant increase of the P(g-a)CO(2) gap compatible with GI hypoperfusion.
van Haren
Frank M P
FM
Department of Intensive Care Medicine, Jeroen Bosch Hospital, PO Box 90153, 5200 ME 's-Hertogenbosch, the Netherlands. fvharen@planet.nl
Rozendaal
Frans W
FW
van der Hoeven
Johannes G
JG
D018806:APACHE; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D003422:Critical Care; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D011014:Pneumonia / Q000150:complications; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D013152:Splanchnic Circulation / Q000187:drug effects*; D014662:Vasoconstrictor Agents / Q000097:blood / Q000627:therapeutic use*; D014667:Vasopressins / Q000097:blood / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D014667:Vasopressins; D009638:Norepinephrine