Cutaneous vascular reactivity and flow motion response to vasopressin in advanced vasodilatory shock and severe postoperative multiple organ dysfunction syndrome.
BACKGROUND
Disturbances in microcirculatory homeostasis have been hypothesized to play a key role in the pathophysiology of multiple organ dysfunction syndrome and vasopressor-associated ischemic skin lesions. The effects of a supplementary arginine vasopressin (AVP) infusion on microcirculation in vasodilatory shock and postoperative multiple organ dysfunction syndrome are unknown.


METHODS
Included in the study were 18 patients who had undergone cardiac or major surgery and had a mean arterial blood pressure below 65 mmHg, despite infusion of more than 0.5 microg/kg per min norepinephrine. Patients were randomly assigned to receive a combined infusion of AVP/norepinephrine or norepinephrine alone. Demographic and clinical data were recorded at study entry and after 1 hour. A laser Doppler flowmeter was used to measure the cutaneous microcirculatory response at randomization and after 1 hour. Reactive hyperaemia and oscillatory changes in the Doppler signal were measured during the 3 minutes before and after a 5-minute period of forearm ischaemia.


RESULTS
Patients receiving AVP/norepinephrine had a significantly higher mean arterial pressure (P = 0.047) and higher milrinone requirements (P = 0.025) than did the patients who received norepinephrine only at baseline. Mean arterial blood pressure significantly increased (P < 0.001) and norepinephrine requirements significantly decreased (P < 0.001) in the AVP/norepinephrine group. Patients in the AVP/norepinephrine group exhibited a significantly higher oscillation frequency of the Doppler signal before ischaemia and during reperfusion at randomization. During the study period, there were no differences in either cutaneous reactive hyperaemia or the oscillatory pattern of vascular tone between groups.


CONCLUSIONS
Supplementary AVP infusion in patients with advanced vasodilatory shock and severe postoperative multiple organ dysfunction syndrome did not compromise cutaneous reactive hyperaemia and flowmotion when compared with norepinephrine infusion alone.
Luckner
Günter
G
Department of Anesthesiology, Innsbruck Medical University, Innsbruck, Austria.
Dünser
Martin W
MW
Stadlbauer
Karl-Heinz
KH
Mayr
Viktoria D
VD
Jochberger
Stefan
S
Wenzel
Volker
V
Ulmer
Hanno
H
Pajk
Werner
W
Hasibeder
Walter R
WR
Friesenecker
Barbara
B
Knotzer
Hans
H
D000368:Aged; D001127:Arginine Vasopressin / Q000494:pharmacology / Q000627:therapeutic use*; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000188:drug therapy* / Q000503:physiopathology; D009638:Norepinephrine / Q000494:pharmacology / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D012769:Shock / Q000188:drug therapy* / Q000503:physiopathology
D001127:Arginine Vasopressin; D009638:Norepinephrine