title: Impact of low-dose vasopressin on trauma outcome: prospective randomized study.
abstract: BACKGROUND
  We previously found that regardless of the animal injury model used resuscitation strategies that minimize fluid administration requirements lead to better outcomes. We hypothesized that a resuscitation regimen that limited the total volume of fluid administered would reduce morbidity and mortality rates in critically ill trauma patients.
  
  
  METHODS
  We performed a double-blind randomized trial to assess the safety and efficacy of adding vasopressin to resuscitative fluid. Subjects were hypotensive adults who had sustained acute traumatic injury. Subjects were given fluid alone (control group) or fluid plus vasopressin (experimental group), first as a bolus (4 IU) and then as an intravenous infusion of 200 ml/h (vasopressin 2.4 IU/h) for 5 h.
  
  
  RESULTS
  We randomly assigned 78 patients to the experimental group (n=38) or the control group (n=40). The groups were similar in age, sex, preexisting medical illnesses, and mechanism and severity of injury. Serum vasopressin concentrations were higher in the experimental group than in the control group at admission, after infusion of vasopressin (p=0.01), and 12 h later. The experimental group required a significantly lower total volume of resuscitation fluid over 5 days than did the control group (p=0.04). The mortality rate at 5 days was 13% in the experimental group and 25% in the control group (p=0.19). The rates of adverse events, organ dysfunction, and 30-day mortality were similar.
  
  
  CONCLUSIONS
  This is the first trial to investigate the impact of vasopressin administration in trauma patients. Infusion of low-dose vasopressin maintained elevated serum vasopressin levels and decreased fluid requirements after injury.
authors.affiliation: Department of Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. cohn@uthscsa.edu
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
authors.forename: Janet
authors.initials: J
authors.lastname: McCarthy
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Stewart
authors.forename: Rachelle B
authors.initials: RB
authors.lastname: Jonas
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Dent
authors.forename: Joel E
authors.initials: JE
authors.lastname: Michalek
mesh_terms: D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012151:Resuscitation; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D014667:Vasopressins / Q000008:administration & dosage*; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins