title: Arginine vasopressin: the future of pressure-support resuscitation in hemorrhagic shock.
abstract: BACKGROUND
  Arginine vasopressin (AVP) is a key player in maintaining the intravascular volume and pressure during hemorrhagic shock. During the past 2 decades, animal studies, case reports, and reviews have documented the minimized blood loss and improved perfusion pressures in those receiving pressure support with AVP.
  
  
  METHODS
  A PubMed search of studies was conducted with the terms: "AVP," "arginine vasopressin," "antidiuretic hormone," "hemorrhagic shock," "hemorrhage," "circulatory shock," "fluid resuscitation," "trauma," "massive transfusion protocol," "physiology," "cerebral," "renal," "cardiac," "perfusion," "dose," and "hypotension." The studies were located by a search of a combination of these terms. Also, within-PubMed citations relating to the studies gathered from the initial search were explored. Reports discussing vasopressin in hemorrhagic states were considered. No predetermined limit was used to choose or exclude articles.
  
  
  RESULTS
  AVP is an important hormone in osmoregulation and blood pressure. During stress, such as hemorrhage, the levels have been shown to rapidly decrease. Furthermore numerous animal studies and limited human studies have shown that circulatory support with AVP is linked to improved outcomes. No large human prospective studies are available to guide its use at present, but some of its effectiveness seems to lie in its ability to increase calcium sensitivity in acidotic environs, thereby allowing for more effective maintenance of vascular tone than catecholamines. It also redirects blood from the periphery, creating a steal syndrome, and increases the oxygen supply to vital organs, minimizing blood loss, and allowing additional time for surgical repair.
  
  
  CONCLUSIONS
  With these encouraging data, there is hope that "pressure support" will be the "resuscitation" considered necessary for a patient's optimum survival.
authors.affiliation: Department of Surgery, Division of Trauma and Surgical Critical Care, Kern Medical Center, Bakersfield, CA 93306, USA. Tanya.anand17@gmail.com
authors.forename: Tanya
authors.initials: T
authors.lastname: Anand
authors.forename: Ruby
authors.initials: R
authors.lastname: Skinner
mesh_terms: D000818:Animals; D001127:Arginine Vasopressin / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000188:drug therapy* / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin