Hemodynamic effects of endobronchial application of ornipressin versus terlipressin.
BACKGROUND
Ornipressin and terlipressin, two ADH-derivates, are instilled endobronchially for bronchoscopy- related bleeding without sufficient evidence of efficacy, nor safety.


OBJECTIVE
To compare the immediate hemodynamic effects of ornipressin and terlipressin used for procedure-related bleeding during flexible bronchoscopy.


METHODS
This retrospective study included patients referred for flexible bronchoscopy who needed administration of ornipressin (15 patients) or terlipressin (15 patients) for procedure-related bleeding. Endobronchial ornipressin (5 IU) or terlipressin (0.5 mg) was administered through the bronchoscope when bleeding persisted for 2 min of continuous suction, or when bleeding was considered increasing in time or major. Hemodynamic data were collected before, during and after administration of either drug.


RESULTS
Biopsy-associated hemoptysis requiring medical treatment occurred in 110 (4.2%) of 2,592 bronchoscopies. After administration of ornipressin, no significant change in heart rate or blood pressure was observed. Following terlipressin instillation, heart rate increased from 93 +/- 17 to 101 +/- 22 b.p.m. (p = 0.03), and blood pressure decreased from 107 +/- 14 to 101 +/- 17 mm Hg (p = 0.04). Oxygen saturation under supplemental nasal oxygen was not different in both groups. None of the 110 patients died from bronchoscopy-related hemoptysis or needed further intervention to stop bleeding or prolonged monitoring because of hemodynamic instability.


CONCLUSIONS
In contrast to ornipressin, administration of terlipressin is associated with significant changes in heart rate and blood pressure. However, these changes are of minor clinical importance, and terlipressin can be safely given for bronchoscopy-associated bleeding.
Division of Respiratory Medicine, University Hospital of Basel, Basel, Switzerland.
Claudia
C
Tüller
David
D
Tüller
Michael
M
Tamm
Martin H
MH
Brutsche
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D006339:Heart Rate / Q000187:drug effects*; D006490:Hemostatics / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009951:Ornipressin / Q000008:administration & dosage / Q000494:pharmacology*; D012189:Retrospective Studies; D000077585:Terlipressin
D006490:Hemostatics; D009951:Ornipressin; D008236:Lypressin; D000077585:Terlipressin