title: Short-term effects of terlipressin bolus infusion on sublingual microcirculatory blood flow during septic shock.
abstract: OBJECTIVE
  Terlipressin bolus infusion may contribute to overshooting increases in systemic vascular resistance with concomitant reductions in systemic blood flow and oxygen delivery. Whether these effects negatively impact on microcirculatory perfusion is still not known. The objective of the present study was, therefore, to elucidate the effects of a single terlipressin bolus dose of 0.5 mg on microcirculatory perfusion in patients with catecholamine-dependent septic shock.
  
  
  METHODS
  This prospective clinical cohort study was performed in a multidisciplinary intensive care unit at a university hospital. We enrolled 20 patients suffering from catecholamine-dependent septic shock. After restoring normovolaemia, norepinephrine (NE) was titrated to maintain mean arterial pressure (MAP) between 65 and 75 mmHg. Thereafter, all patients received a bolus infusion of 0.5 mg terlipressin, and NE was adjusted to maintain MAP between the threshold values. Sublingual microcirculatory blood flow of small vessels was assessed by sidestream dark-field imaging. All measurements, including data from right heart catheterization and NE requirements, were obtained at baseline and 6 h after terlipressin administration.
  
  
  RESULTS
  Terlipressin stabilized haemodynamics and, at the same time, decreased NE requirements (0.42 ± 0.67 vs. 0.74 ± 0.73 μg/kg per minute, p<0.05). Whereas the pH and arterial lactate concentrations remained unchanged, microcirculatory flow index of small vessels had increased at the end of the 6-h study period (2.6 ± 0.6 vs. 2.0 ± 0.5 units, p<0.05).
  
  
  CONCLUSIONS
  In fluid-resuscitated patients with septic shock (with a MAP between 65 and 75 mmHg), a bolus infusion of 0.5 mg terlipressin was effective in reducing NE requirements without worsening microcirculatory blood flow. Randomized clinical trials are now warranted to verify these preliminary results.
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Rome, Sapienza, Viale del Policlinico 155, 00161 Rome, Italy. andrea.morelli@uniroma1.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Morelli
authors.forename: Abele
authors.initials: A
authors.lastname: Donati
authors.forename: Christian
authors.initials: C
authors.lastname: Ertmer
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rehberg
authors.forename: Alessandra
authors.initials: A
authors.lastname: Orecchioni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Russo
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelaia
authors.forename: Paolo
authors.initials: P
authors.lastname: Pietropaoli
authors.forename: Martin
authors.initials: M
authors.lastname: Westphal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology; D000077585:Terlipressin; D014655:Vascular Resistance / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000494:pharmacology* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin