Endocrinologic response to vasopressin infusion in advanced vasodilatory shock.
OBJECTIVE
To evaluate the endocrinologic response to a combined arginine vasopressin and norepinephrine (AVP/NE) infusion in advanced vasodilatory shock, and to examine the relationship between baseline plasma AVP concentrations and the hemodynamic response to AVP.


METHODS
Preliminary, prospective, randomized, controlled clinical study.


METHODS
Twenty-three-bed general and surgical intensive care unit.


METHODS
Thirty-eight patients with advanced vasodilatory shock. Hemodynamic and laboratory data of 34 patients have already been presented in a recently published prospective, randomized, controlled study.


METHODS
Continuous AVP (4 units/hr) and NE infusion in study patients; NE infusion only in control patients.


RESULTS
At baseline, 24 hrs, and 48 hrs after randomization, plasma concentrations of AVP, adrenocorticotropic hormone, cortisol, renin, angiotensin II, aldosterone, prolactin, endothelin I, and atrial natriuretic factor were determined. Hemodynamic variables were recorded at baseline and 1, 12, and 24 hrs after randomization. Linear mixed effects models were used to test for differences between groups. The relationship between AVP plasma concentrations and hemodynamic response to AVP was analyzed using linear regression analyses. AVP/NE patients exhibited significantly higher AVP (p <.001) and prolactin (p <.001) plasma concentrations during the study period; there were no significant differences in plasma concentrations of other hormones. No significant correlation was detected between plasma AVP concentrations and the increase in mean arterial pressure after 1 hr (Pearson's correlation coefficient =.134, p =.584) and after 24 hrs (Pearson's correlation coefficient = -.198, p =.417). There were further no correlations between AVP plasma concentrations and the 24-hr response to AVP therapy in heart rate (Pearson's correlation coefficient = -.065, p =.791), stroke volume index (Pearson's correlation coefficient = -.106, p =.687), and NE requirements (Pearson's correlation coefficient =.04, p =.869).


CONCLUSIONS
The preliminary results of this study indicate that a combined AVP and NE infusion increases prolactin plasma concentrations in advanced vasodilatory shock. Hemodynamic effects of AVP infusion are independent of baseline plasma AVP concentrations.
Dünser
Martin W
MW
Division of General and Surgical Intensive Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Leopold-Franzens-University of Innsbruck, Innsbruck, Austria.
Hasibeder
Walter R
WR
Wenzel
Volker
V
Schwarz
Siegfried
S
Ulmer
Hanno
H
Knotzer
Hans
H
Pajk
Werner
W
Friesenecker
Barbara E
BE
Mayr
Andreas J
AJ
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000368:Aged; D000450:Aldosterone / Q000097:blood; D000804:Angiotensin II / Q000097:blood; D001127:Arginine Vasopressin / Q000008:administration & dosage* / Q000097:blood; D009320:Atrial Natriuretic Factor / Q000097:blood; D004702:Endocrine Glands / Q000187:drug effects*; D019332:Endothelin-1; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007262:Infusions, Intravenous; D008297:Male; D009638:Norepinephrine / Q000008:administration & dosage; D011388:Prolactin / Q000097:blood; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D012769:Shock / Q000188:drug therapy / Q000503:physiopathology*
D019332:Endothelin-1; D000804:Angiotensin II; D001127:Arginine Vasopressin; D000450:Aldosterone; D009320:Atrial Natriuretic Factor; D000324:Adrenocorticotropic Hormone; D011388:Prolactin; D012083:Renin; D006854:Hydrocortisone; D009638:Norepinephrine