title: Current place of vasopressin analogues in the treatment of septic shock.
abstract: Arginine vasopressin and terlipressin increase mean arterial pressure and reduce catecholamine requirements in septic shock patients. Infusing either agent may reduce incidence of new-onset tachyarrhythmias and improve renal function. The recent Vasopressin and Septic Shock Trial did not demonstrate an overall survival benefit of arginine vasopressin infusion (0.03 U/min) compared with norepinephrine (15 microg/min). However, patients with less severe septic shock (ie, < 15 microg/min of norepinephrine) at arginine vasopressin initiation had a lower 28-day mortality rate compared with norepinephrine-only infusion (26.5% vs 35.7%; P = 0.05). An unpublished study comparing terlipressin (1.3 microg/kg/h), arginine vasopressin (0.03 U/min), and norepinephrine (15 microg/min) as first-line vasopressors showed that terlipressin had higher efficacy than arginine vasopressin in reducing catecholamine requirements. Current literature suggests that early infusion of low-dose continuous arginine vasopressin or terlipressin appears superior to a last-resort treatment. However, because no large clinical trials have proven terlipressin's safety in patients with septic shock, arginine vasopressin is preferred until more data are available.
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital of Muenster, Albert-Schweitzer-Str. 33, D-48149 Münster, Germany. ertmerc@gmx.net
authors.forename: Christian
authors.initials: C
authors.lastname: Ertmer
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rehberg
authors.forename: Andrea
authors.initials: A
authors.lastname: Morelli
authors.forename: Martin
authors.initials: M
authors.lastname: Westphal