title: Methylprednisolone reverses vasopressin hyporesponsiveness in ovine endotoxemia.
abstract: Tachyphylaxis against catecholamines often complicates hemodynamic support in patients with septic shock. Recent experimental and clinical research suggests that the hemodynamic response to exogenous arginine vasopressin (AVP) infusion may also be blunted. The purpose of the present study was therefore to clarify whether the efficacy of a continuous AVP infusion (0.04 U x min(-1)) decreases over time in ovine endotoxemia. An additional objective was to determine whether the anticipated hyporesponsiveness can be counteracted by corticosteroids. Fourteen adult ewes (37 +/- 1 kg) were instrumented for chronic hemodynamic monitoring. All ewes received a continuous endotoxin infusion that contributed to a hypotensive-hyperdynamic circulation. After 16 h of endotoxemia, the sheep were randomized to receive either AVP (0.04 U x min(-1)) or the vehicle (normal saline; n = 7 each). After 6 h of AVP or placebo infusion, respectively, methylprednisolone (30 mg x kg(-1)) was injected. Arginine vasopressin infusion increased mean arterial pressure and systemic vascular resistance index at the expense of a reduced cardiac index (P < 0.05 each). Supraphysiologic AVP plasma levels in the treatment group (298 +/- 15 pg x mL(-1)) were associated with increased surrogate parameters of liver, mesenterial, and myocardial dysfunction. After 6 h of continuous AVP infusion, the vasopressor effect was significantly reduced. Interestingly, a bolus infusion of methylprednisolone (30 mg x kg(-1)) reestablished mean arterial pressure by increasing both cardiac index and systemic vascular resistance index. The present study demonstrates that in endotoxemia, (a) the vasopressor effect of AVP infusion may be reduced, (b) corticosteroids may potentially be useful to increase the efficacy of AVP infusion, and (c) even moderate AVP doses may potentially impair myocardial and hepatic function.
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Muenster, Muenster, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ertmer
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Bone
authors.forename: Andrea
authors.initials: A
authors.lastname: Morelli
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Aken
authors.forename: Michael
authors.initials: M
authors.lastname: Erren
authors.forename: Matthias
authors.initials: M
authors.lastname: Lange
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Traber
authors.forename: Martin
authors.initials: M
authors.lastname: Westphal
mesh_terms: D000305:Adrenal Cortex Hormones / Q000378:metabolism; D000818:Animals; D001127:Arginine Vasopressin / Q000378:metabolism / Q000494:pharmacology; D001794:Blood Pressure; D019446:Endotoxemia / Q000378:metabolism*; D004731:Endotoxins / Q000378:metabolism; D005260:Female; D008775:Methylprednisolone / Q000494:pharmacology*; D010100:Oxygen / Q000378:metabolism; D011312:Pressure; D018805:Sepsis; D012756:Sheep; D012769:Shock / Q000188:drug therapy*; D013997:Time Factors; D014667:Vasopressins / Q000378:metabolism*
chemical_list: D000305:Adrenal Cortex Hormones; D004731:Endotoxins; D014667:Vasopressins; D001127:Arginine Vasopressin; D010100:Oxygen; D008775:Methylprednisolone