Review article: organ perfusion/permeability-related effects of norepinephrine and vasopressin in sepsis.
OBJECTIVE
One invariable hallmark of severe sepsis is generalized tissue "malperfusion" and hyperpermeability secondary to microcirculatory/capillary leakage. This review focuses on direct and/or indirect influences of norepinephrine, as a standard of care, and vasopressin, as an alternative vasoactive drug, on organ and tissue perfusion/permeability in severe sepsis.


METHODS
English and French language articles and books published between 1966 and 2005 were identified through a computerized Medline search using the terms "sepsis, permeability, norepinephrine and vasopressin". Relevant publications were retrieved and scanned for additional sources.


RESULTS
There are few randomized clinical trials comparing different vasopressors in sepsis; most available literature consists of clinical reports, animal experiments and occasional reviews. Based on the best current evidence from these sources, we describe the status of major organ perfusion/permeability in sepsis (i.e., the lung, the kidney, the heart, the intestine/gut) in the context of sepsis-induced organ dysfunction/failure. Potential and differential therapeutic effects of the vasopressors norepinephrine and arginine-vasopressin, in the setting of sepsis, are identified.


CONCLUSIONS
In the treatment of sepsis, arginine-vasopressin exhibits organ-specific heterogeneity in vascular responsiveness, compared to norepinephrine. While norepinephrine is a current standard of care in sepsis, arginine-vasopressin shows promise for the treatment of septic shock.
Farand
Paul
P
Laboratoire de Physiologie Rénale et Vasculaire, Quebec, Canada.
Hamel
Mélanie
M
Lauzier
François
F
Plante
Gérard E
GE
Lesur
Olivier
O
D000818:Animals; D001127:Arginine Vasopressin / Q000494:pharmacology / Q000627:therapeutic use*; D002199:Capillary Permeability / Q000187:drug effects*; D042783:Endothelial Cells / Q000378:metabolism; D004847:Epithelial Cells / Q000378:metabolism; D006321:Heart / Q000503:physiopathology; D006801:Humans; D007422:Intestines / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology; D009638:Norepinephrine / Q000494:pharmacology / Q000627:therapeutic use*; D018805:Sepsis / Q000188:drug therapy* / Q000503:physiopathology
D001127:Arginine Vasopressin; D009638:Norepinephrine