Comparison of two dose regimens of arginine vasopressin in advanced vasodilatory shock.
OBJECTIVE
To evaluate the effects of two arginine vasopressin (AVP) dose regimens (0.033 vs. 0.067 IU/min) on treatment efficacy, hemodynamic response, prevalence of adverse events, and changes in laboratory variables.


METHODS
Retrospective, controlled study.


METHODS
A total of 78 patients with vasodilatory shock (mean norepinephrine dosage, 1.07 microg.kg-1.min-1; 95% confidence interval, 0.82-1.56 microg.kg-1.min-1).


METHODS
Supplementary infusion of AVP at 0.033 (n = 39) and 0.067 IU/min (n = 39).


RESULTS
Cardiocirculatory, laboratory, and clinical variables were evaluated and compared between groups before and at 0.5, 1, 4, 12, 24, 48, and 72 hrs after initiation of AVP. Treatment efficacy was assessed by the increase in mean arterial blood pressure and the extent of norepinephrine reduction during the first 24 hrs of AVP therapy. Standard tests and a mixed-effects model were used for statistical analysis. Although the relative increase in mean arterial pressure was comparable between groups (0.033 vs. 0.067 IU/min: 16.8 +/- 18.4 vs. 21.4 +/- 14.9 mm Hg, p = .24), norepinephrine could be reduced significantly more often in patients receiving 0.067 IU/min. AVP at 0.067 IU/min resulted in a higher mean arterial pressure (p < .001), lower central venous pressure (p = .001), lower mean pulmonary arterial pressure (p = .04), and lower norepinephrine requirements (p < .001) during the 72-hr observation period. Increases in liver enzymes occurred more often in patients treated with 0.033 IU/min (71.8% vs. 28.2%, p < .001). The prevalence of a decrease in cardiac index (69.2% vs. 53.8%, p = .24), decrease in platelet count (94.8% vs. 84.6%, p = .26), and increase in total bilirubin (48.7% vs. 71.8%, p = .06) was not significantly different between groups. Bilirubin levels (3.1 +/- 3.4 vs. 5.2 +/- 5.5 mg/dL, p = .04) and base deficit (-7.2 +/- 4.3 vs. -3.9 +/- 5.9 mmol/L, p = .005) were lower and arterial lactate concentrations higher (76 +/- 67 vs. 46 +/- 38 mg/dL, p < .001) in patients receiving 0.033 IU/min.


CONCLUSIONS
AVP dosages of 0.067 IU/min seem to be more effective to reverse cardiovascular failure in vasodilatory shock requiring high norepinephrine dosages than 0.033 IU/min.
Luckner
Günter
G
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria. Guenter.Luckner@i-med.ac.at
Mayr
Viktoria D
VD
Jochberger
Stefan
S
Wenzel
Volker
V
Ulmer
Hanno
H
Hasibeder
Walter R
WR
Dünser
Martin W
MW
D000368:Aged; D001127:Arginine Vasopressin / Q000008:administration & dosage*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012769:Shock / Q000188:drug therapy*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D014664:Vasodilation
D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin