Vasopressin in vasodilatory shock: ensure organ blood flow, but take care of the heart!
Supplementary arginine vasopressin infusion in advanced vasodilatory shock may be accompanied by a decrease in cardiac index and systemic oxygen transport capacity in approximately 40% of patients. While a reduction of cardiac output most frequently occurs in patients with hyperdynamic circulation, it is less often observed in patients with low cardiac index. Infusion of inotropes, such as dobutamine, may be an effective strategy to restore systemic blood flow. However, when administering inotropic drugs, systemic blood flow should be increased to adequately meet systemic demands (assessed by central or mixed venous oxygen saturation) without putting an excessive beta-adrenergic stress on the heart. Overcorrection of cardiac index to hyperdynamic values with inotropes places myocardial oxygen supply at significant risk.
Dünser
Martin W
MW
Department of Intensive Care Medicine, Inselspital Bern, Murtenstrasse, 3010 Bern, Switzerland. Martin.Duenser@uibk.ac.at
Hasibeder
Walter R
WR
D000318:Adrenergic beta-Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D000818:Animals; D001127:Arginine Vasopressin / Q000009:adverse effects*; D004280:Dobutamine / Q000009:adverse effects / Q000627:therapeutic use*; D019446:Endotoxemia; D006321:Heart / Q000187:drug effects*; D006339:Heart Rate / Q000187:drug effects; D006490:Hemostatics / Q000494:pharmacology*; D006801:Humans; D010101:Oxygen Consumption / Q000187:drug effects; D012039:Regional Blood Flow / Q000187:drug effects; D012307:Risk Factors; D012756:Sheep; D012769:Shock
D000318:Adrenergic beta-Agonists; D006490:Hemostatics; D001127:Arginine Vasopressin; D004280:Dobutamine