Arginine vasopressin in septic shock: supplement or substitute for norepinephrine?
In the current issue of Critical Care, Simon and coworkers investigated the effects of first-line arginine vasopressin (AVP) on organ function and systemic metabolism compared with norepinephrine in a pig model of fecal peritonitis. AVP was titrated according to the mean arterial pressure suggesting a vasopressor rather than a hormone replacement therapy. The study provides some evidence for the safety of this therapeutic approach. It needs to be determined whether AVP is most beneficial as a constant low-dose infusion to supplement norepinephrine or in higher doses than currently recommended to substitute norepinephrine. In addition, future studies are warranted to evaluate whether a first-line therapy of AVP is superior to a last-resort administration.
Rehberg
Sebastian
S
Investigational Intensive Care Unit, Department of Anesthesiology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA. serehber@utmb.edu
Enkhbaatar
Perenlei
P
Traber
Daniel L
DL
D000818:Animals; D001127:Arginine Vasopressin / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D064420:Drug-Related Side Effects and Adverse Reactions; D009638:Norepinephrine / Q000627:therapeutic use*; D012772:Shock, Septic / Q000188:drug therapy*; D034421:Sus scrofa; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin; D009638:Norepinephrine
Intensive Care Med. 2006 Nov;32(11):1782-9
17019548
Crit Care Med. 2007 Oct;35(10):2280-5
17944015
Crit Care Med. 2004 Jan;32(1):194-200
14707579
Crit Care Med. 2005 Nov;33(11):2659-66
16276194
Crit Care Med. 2003 Nov;31(11):2646-50
14605537
Crit Care Med. 2008 Jan;36(1):296-327
18158437
N Engl J Med. 2008 Feb 28;358(9):877-87
18305265
Circulation. 2003 May 13;107(18):2313-9
12732600
Crit Care. 2009;13(4):R113
19591694
Circulation. 1997 Mar 4;95(5):1122-5
9054839
Am J Respir Crit Care Med. 2003 Aug 15;168(4):481-6
12791578
Intensive Care Med. 2009 Jul;35(7):1286-96
19360396
Crit Care Med. 2002 Mar;30(3):702-3
11990939