Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline

Nascente, Ana Paula Metran; Freitas, Flávio Geraldo Rezende; Bakker, Jan; Bafi, Antônio Tonete; Ladeira, Renata Teixeira; Azevedo, Luciano César Pontes; Lima, Alexandre; Machado, Flávia Ribeiro

doi:10.6061/clinics/2017(12)06

Cited by 10 publications

(11 citation statements)

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“…In another study, lactate concentration was reported to be associated with the hemodynamic response of vasopressin [ 58 ]. In the study by Nascente et al, they found vasopressin administration is likely to improve microcirculation in septic shock patients whose baseline noradrenaline dose was higher than 0.38 μg/kg/min [ 59 ]. Therefore, uncovering specific subgroups of septic patients who are most likely to respond to early initiation of vasopressin is important [ 58 ].…”

Section: Discussionmentioning

confidence: 99%

The effects and safety of vasopressin receptor agonists in patients with septic shock: a meta-analysis and trial sequential analysis

et al. 2019

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BackgroundThe aim of this study was to evaluate the effects and safety of vasopressin receptor agonists in patients with septic shock.MethodsPubMed, EMBASE, and Cochrane library were searched for randomized controlled trials evaluating the effects of vasopressin receptor agonists in septic shock patients. Two reviewers performed literature selection, data extraction, and quality evaluation independently. The primary outcome was mortality. And secondary outcomes included intensive care unit (ICU) length of stay, duration of mechanical ventilation, and incidence of adverse events. In addition, a trial sequential analysis (TSA) was performed.ResultsTwenty studies were eligible for meta-analysis. The results showed vasopressin receptor agonists use was associated with reduced mortality (relative risk (RR) 0.92; 95% confidence interval (CI) 0.84 to 0.99; I2 = 0%). Nevertheless, they had no significant effects on ICU length of stay (mean deviation (MD) − 0.08, 95% CI, − 0.68 to 0.52, I2 = 0%) and duration of mechanical ventilation (MD − 0.58, 95% CI − 1.47 to 0.31, I2 = 57%). Additionally, there was no significant difference in total adverse events between two groups (RR 1.28, 95% CI 0.87 to 1.90, I2 = 57%), but vasopressin receptor agonists administration could significantly increase the risk of digital ischemia (RR 4.85, 95% CI 2.81 to 8.39, I2 = 26%). Finally, there was no statistical difference of cardiovascular events (RR 0.91, 95% CI 0.53 to 1.57, I2 = 1%), arrhythmia (0.77, 95% CI 0.48 to 1.23, I2 = 23%), mesenteric ischemia (0.83, 95% CI 0.44 to 1.55, I2 = 0%), diarrhea (2.47, 95% CI 0.77 to 7.96, I2 = 49%), cerebrovascular events (1.36, 95% CI 0.18 to 10.54, I2 = 0%), and hyponatremia (1.47, 95% CI 0.84 to 2.55, I2 = 0%) between two groups. Egger’s test showed there was no significant publication bias among studies (P = 0.36).ConclusionsThe use of vasopressin might result in reduced mortality in patients with septic shock. An increased risk of digital ischemia must be taken into account.Electronic supplementary materialThe online version of this article (10.1186/s13054-019-2362-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The effects and safety of vasopressin receptor agonists in patients with septic shock: a meta-analysis and trial sequential analysis

et al. 2019

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“…The effects of vasopressin may markedly change depending on the dosage administered ( 31 , 32 ), and, hence, vasopressin loading at other dosages needs to be investigated. In addition, several factors, including norepinephrine and vasopressin doses, may influence responses to vasopressin and other outcomes ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

Vasopressin Loading for Refractory Septic Shock: A Preliminary Analysis of a Case Series

et al. 2021

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Background: Vasopressin is one of the strong vasopressor agents associated with ischemic events. Responses to the administration of vasopressin differ among patients with septic shock. Although the administration of a high dose of vasopressin needs to be avoided, the effects of bolus loading have not yet been examined. Since the half-life of vasopressin is longer than that of catecholamines, we hypothesized that vasopressin loading may be effective for predicting responses to its continuous administration.Methods: We retrospectively analyzed consecutive cases of septic shock for which vasopressin was introduced with loading under noradrenaline at >0.2 μg/kg/min during the study period. Vasopressin was administered in a 1 U bolus followed by its continuous administration at 1 U/h. The proportion of patients with a negative catecholamine index (CAI) change 6 h after the introduction of vasopressin was set as the primary outcome. We defined non-responders for exploration as those with a mean arterial pressure change <18 mmHg 1 min after vasopressin loading, among whom none had a change in CAI <0.Results: Twenty-one consecutive cases were examined in the present study, and included 14 responders and 7 non-responders. The primary outcome accounted for 71.4% of responders and 0% of non-responders, with a significant difference (p = 0.0039). Median CAI changes 2, 4, and 6 h after the administration of vasopressin were 0, −5, and −10 in responders and +20, +10, and +10 in non-responders, respectively. CAI was not reduced in any non-responder. Outcomes including mortality were not significantly different between responders and non-responders. Digital ischemia (1/21) and mesenteric ischemia (1/21) were observed.Conclusions: Vasopressin loading may predict responses to its continuous administration in septic shock patients. Further investigations involving a safety analysis are needed.

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“…Role and adverse effects of VP are described in detail in the text [22][23][24][25][26][27][28][29][30][31][32][33].…”

Section: Spg-symmetrical Peripheral Gangrenementioning

confidence: 99%

Efficacy and Safety of Vasopressin Alone or in Combination With Catecholamines in the Treatment of Septic Shock: A Systematic Review

Mandal¹,

Kham²,

Shahid³

et al. 2022

Cureus

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Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline

Cited by 10 publications

References 36 publications

The effects and safety of vasopressin receptor agonists in patients with septic shock: a meta-analysis and trial sequential analysis

The effects and safety of vasopressin receptor agonists in patients with septic shock: a meta-analysis and trial sequential analysis

Vasopressin Loading for Refractory Septic Shock: A Preliminary Analysis of a Case Series

Efficacy and Safety of Vasopressin Alone or in Combination With Catecholamines in the Treatment of Septic Shock: A Systematic Review

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