title: Fixed-dose vasopressin compared with titrated dopamine and norepinephrine as initial vasopressor therapy for septic shock.
abstract: OBJECTIVE
  To investigate the early blood pressure effects of vasopressin compared with titrated catecholamines as initial drug therapy in patients with septic shock.
  
  
  METHODS
  Retrospective cohort, single-center study.
  
  
  METHODS
  Intensive care units at the Mayo Clinic, Rochester, Minnesota.
  
  
  METHODS
  Fifty, 49, and 51 intensive care patients treated initially with vasopressin, norepinephrine, and dopamine, respectively.
  
  
  METHODS
  Patients received either intravenous infusion of fixed-dose vasopressin 0.04 U/minute or titrated infusions of norepinephrine or dopamine for low systemic arterial pressures.
  
  
  RESULTS
  Patients treated with vasopressin, norepinephrine, and dopamine were similar in all measured characteristics except for their score on the Acute Physiology and Chronic Health Evaluation (APACHE) III (dopamine > vasopressin, p=0.049), renal comorbidities (dopamine > vasopressin, p=0.03) and baseline mean arterial pressure (MAP) (norepinephrine < vasopressin, p=0.005 or dopamine < vasopressin, p=0.05). In all patients, MAP 1 hour before and 1 hour afte intervention, heart rate, and systolic blood pressure were obtained. No treatment differences were identified in achieving postvasopressin MAP after adjusting for APACHE III score, renal dysfunction, and baseline MAP. In patients receiving vasopressin, 28-day mortality was 52%, similar to those receiving norepinephrine (65%, p=0.28) and dopamine (60%, p=0.53).
  
  
  CONCLUSIONS
  Initial, fixed-dose vasopressin infusions increased MAP to 70 mm Hg or greater at 1 hour in intensive care patients with septic shock, similar to titrated norepinephrine or dopamine. Fixed-dose vasopressin appears appropriate as an alternative agent for hemodynamic support in patients with septic shock.
authors.affiliation: Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota 55902, USA.
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Hall
authors.forename: Lance J
authors.initials: LJ
authors.lastname: Oyen
authors.forename: C Burcin
authors.initials: CB
authors.lastname: Taner
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cullinane
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Baird
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Cha
authors.forename: Mark D
authors.initials: MD
authors.lastname: Sawyer
mesh_terms: D018806:APACHE; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output; D004298:Dopamine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000145:classification / Q000188:drug therapy* / Q000401:mortality; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D014667:Vasopressins / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004298:Dopamine; D009638:Norepinephrine