title: Moderate-dose vasopressin therapy may impair gastric mucosal perfusion in severe sepsis: a pilot study.
abstract: BACKGROUND
  The effects of moderate-dose vasopressin on gastric mucosal perfusion and its relation to global and hepatosplanchnic hemodynamic and oxygen transport variables were investigated in patients with severe sepsis.
  
  
  METHODS
  Vasopressin was administered at a dose of 0.04 IU · kg⁻¹ · h⁻¹ over 4 h in 12 patients with severe sepsis who were receiving norepinephrine. During the study period, the norepinephrine infusion rate was reduced to keep mean arterial blood pressure constant. Hepatosplanchnic blood flow, oxygen delivery, and oxygen consumption (via hepatic venous catheterization using the Fick principle and continuous indocyanine green infusion technique), global hemodynamics (transpulmonary thermodilution method), and the difference between the gastric mucosal and arterial carbon dioxide tension (Pco₂-gap) were measured at baseline and 4 h after the start of the vasopressin infusion.
  
  
  RESULTS
  The administration of 0.04 IU · kg⁻¹ · h⁻¹ vasopressin over 4 h was associated with minimal changes in global hemodynamics. Heart rate decreased slightly from 99 [81-115] (median [interquartile range]) to 96 [74-109] beats/min (P = 0.016) and cardiac index from 3.7 [2.8-4.7] to 3.5 [2.7-3.6] L · min⁻¹ · m⁻² (P = 0.003). Global oxygen delivery index decreased significantly from 461 [375-637] to 419 [352-551] ml · min⁻¹ · m⁻² (P = 0.002), whereas hepatosplanchnic blood flow and oxygen uptake remained unchanged. Gastric mucosal Pco₂-gap increased significantly from 13.3 [8.0-16.7] to 17.1 [10.3-28.7] mmHg (P = 0.002), suggesting that blood flow may have been redistributed away from the gut mucosa.
  
  
  CONCLUSIONS
  Vasopressin at a dosage of 0.04 IU · kg⁻¹ · h⁻¹ may impair gastric mucosal perfusion with minimal global hemodynamic effects.
authors.affiliation: Department of Anesthesiology and Intensive Care, Friedrich Schiller University, Jena, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Klinzing
authors.forename: Mark
authors.initials: M
authors.lastname: Simon
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.forename: Andreas
authors.initials: A
authors.lastname: Meier-Hellmann
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply* / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects / Q000502:physiology; D010865:Pilot Projects; D018805:Sepsis / Q000188:drug therapy* / Q000503:physiopathology; D014667:Vasopressins / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D014667:Vasopressins