1517: Vasopressin Versus Norepinephrine as the First-Line Vasopressor in Septic Shock: A Meta-Analysis

Sedhai, Yub Raj; Shrestha, Dhan Bahadur; Budhathoki, Pravash; Memon, Waqas; Acharya, Rajesh; Asija, Ankush; Gaire, Suman; Pokharel, Nisheem; Maharjan, Swojay; Jasaraj, Ranjit; Kadaria, Dipen; Kashiouris, Markos

doi:10.1097/01.ccm.0000812392.83483.a3

Cited by 2 publications

(2 citation statements)

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“…The goal is not only to resuscitate the cardiovascular system but also to limit the side effects due to adrenergic overload [132,144]. However, two recent meta-analyses assessing the effect of VP administration concluded that its early initiation was not associated with a decrease in short-term mortality, a shorter ICU length of stay, or LOS, but can reduce the use of renal replacement therapy (RRT) [145,146].…”

Section: Vasoactive Agentsmentioning

confidence: 99%

2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department

Guarino

Perna

Cesaro

et al. 2023

JCM

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Background: Sepsis/septic shock is a life-threatening and time-dependent condition that requires timely management to reduce mortality. This review aims to update physicians with regard to the main pillars of treatment for this insidious condition. Methods: PubMed, Scopus, and EMBASE were searched from inception with special attention paid to November 2021–January 2023. Results: The management of sepsis/septic shock is challenging and involves different pathophysiological aspects, encompassing empirical antimicrobial treatment (which is promptly administered after microbial tests), fluid (crystalloids) replacement (to be established according to fluid tolerance and fluid responsiveness), and vasoactive agents (e.g., norepinephrine (NE)), which are employed to maintain mean arterial pressure above 65 mmHg and reduce the risk of fluid overload. In cases of refractory shock, vasopressin (rather than epinephrine) should be combined with NE to reach an acceptable level of pressure control. If mechanical ventilation is indicated, the tidal volume should be reduced from 10 to 6 mL/kg. Heparin is administered to prevent venous thromboembolism, and glycemic control is recommended. The efficacy of other treatments (e.g., proton-pump inhibitors, sodium bicarbonate, etc.) is largely debated, and such treatments might be used on a case-to-case basis. Conclusions: The management of sepsis/septic shock has significantly progressed in the last few years. Improving knowledge of the main therapeutic cornerstones of this challenging condition is crucial to achieve better patient outcomes.

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Section: Vasoactive Agentsmentioning

confidence: 99%

2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department

Guarino

Perna

Cesaro

et al. 2023

JCM

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“…On the other hand, smaller arterioles do not show differences between treatments in rodents' microcirculation [40]. Hence, AVP has clinical importance and use in advanced hypovolemic or vasodilatory shock states [41].…”

Section: The Physiological Role Of Arginine Vasopressinmentioning

confidence: 99%

The Role of Arginine-Vasopressin in Stroke and the Potential Use of Arginine-Vasopressin Type 1 Receptor Antagonists in Stroke Therapy: A Narrative Review

Chojnowski

Opiełka

Gozdalski

et al. 2023

IJMS

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Stroke is a life-threatening condition in which accurate diagnoses and timely treatment are critical for successful neurological recovery. The current acute treatment strategies, particularly non-invasive interventions, are limited, thus urging the need for novel therapeutical targets. Arginine vasopressin (AVP) receptor antagonists are emerging as potential targets to treat edema formation and subsequent elevation in intracranial pressure, both significant causes of mortality in acute stroke. Here, we summarize the current knowledge on the mechanisms leading to AVP hyperexcretion in acute stroke and the subsequent secondary neuropathological responses. Furthermore, we discuss the work supporting the predictive value of measuring copeptin, a surrogate marker of AVP in stroke patients, followed by a review of the experimental evidence suggesting AVP receptor antagonists in stroke therapy. As we highlight throughout the narrative, critical gaps in the literature exist and indicate the need for further research to understand better AVP mechanisms in stroke. Likewise, there are advantages and limitations in using copeptin as a prognostic tool, and the translation of findings from experimental animal models to clinical settings has its challenges. Still, monitoring AVP levels and using AVP receptor antagonists as an add-on therapeutic intervention are potential promises in clinical applications to alleviate stroke neurological consequences.

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1517: Vasopressin Versus Norepinephrine as the First-Line Vasopressor in Septic Shock: A Meta-Analysis

Cited by 2 publications

References 0 publications

2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department

2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department

The Role of Arginine-Vasopressin in Stroke and the Potential Use of Arginine-Vasopressin Type 1 Receptor Antagonists in Stroke Therapy: A Narrative Review

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