Effects of vasopressin in septic shock.
Septic shock continues to be one of the leading causes of death in the intensive care unit today. The confluence of many factors contributes to the deterioration of patients' condition in septic shock. Increased levels of nitric oxide, in part, mediate the cardiovascular effects of septic shock. Nitric oxide is major mediator of vasodilation and hypotension as well as myocardial depression. It also contributes to decreased production and release of endogenous vasopressin. Vasopressin effects are actualized by stimulation of V1, V2, and V3 receptors located in various parts of the body. The response is dose dependent. Endogenous vasopressin and angiotensin II act synergistically to preserve and restore blood pressure levels. Decreased circulating vasopressin contributes to adrenal insufficiency via hypothalamic-pituitary-adrenal axis suppression and increased catecholamine resistance to vasopressors. Exogenous vasopressin supplementation in physiologic doses has been shown to improve blood pressure levels and decrease vasopressor needs in patients with septic shock.
Ruggiero
Margaret S
MS
Surgical Critical Care Services, Washington Hospital Center, 110 Irving St, Washington, DC 20010, USA. Gosia1122@aol.com
D000368:Aged; D000804:Angiotensin II / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D003422:Critical Care / Q000379:methods; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000502:physiology; D009569:Nitric Oxide / Q000502:physiology; D009730:Nursing Assessment; D017060:Patient Satisfaction; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000502:physiology; D017410:Practice Guidelines as Topic; D017483:Receptors, Vasopressin / Q000187:drug effects / Q000502:physiology; D012772:Shock, Septic / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000494:pharmacology / Q000627:therapeutic use*; D014667:Vasopressins / Q000494:pharmacology / Q000502:physiology / Q000627:therapeutic use
D017483:Receptors, Vasopressin; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D000804:Angiotensin II; D009569:Nitric Oxide