A Selective V1A Receptor Agonist, Selepressin, Is Superior to Arginine Vasopressin and to Norepinephrine in Ovine Septic Shock*

Abstract

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Sepsis and septic shock

“…One of several approaches being investigated to address oedema and endothelial injury is the use of selepressin, a selective vasopressin type 1a receptor agonist that increases arterial pressure and has the potential to reduce vascular leakage and pulmonary oedema. Preclinical studies in an ovine model of septic shock showed clear survival benefits of selepressin over vasopressin and noradrenaline, especially when administered early 121 .…”

Perioperative Management of Adrenalectomy and Inferior Vena Cava Reconstruction in a Patient With a Large, Malignant Pheochromocytoma With Vena Caval Extension

“…Arginine vasopressin administration only has been recommended to treat refractory shock in intensive care units. 56 …”

Selepressin in Septic Shock

“…What do we learn from the study by He et al (17)? Clearly, this study is the logical extension of the above-mentioned previous article by Maybauer et al (16), and it elegantly confirms these authors' conclusion that selepressin indeed compares favorably with AVP and the clinical standard vasopressor norepinephrine with respect to plasma leakage into the extravascular space: since fluid intake and diuresis were comparable in the three treatment groups, any beneficial, selepressinrelated effect on tissue edema must have resulted from less pronounced vascular barrier "porosity" (8).…”

“…What are possible clinical implications of the study by He et al (17)? The beneficial effects of the selepressin treatment were particularly pronounced in the early intervention arm, and selepressin was not combined with the clinical standard norepinephrine.…”

“…The driving mechanistic question remains pertinent: What are the mechanisms of the attenuated vascular leakage in the study by He et al (17)? Unfortunately, the authors did not provide any tissue Western blotting nor histological and immunohistochemistry findings to address mechanisms.…”