Comparing two different arginine vasopressin doses in advanced vasodilatory shock: a randomized, controlled, open-label trial

Torgersen, Christian; Dünser, Martin W.; Wenzel, Volker; Jochberger, Stefan; Mayr, Viktoria D.; Schmittinger, Christian A.; Lorenz, Ingo; Schmid, Stefan; Westphal, Martin; Grander, Wilhelm; Luckner, Günter

doi:10.1007/s00134-009-1630-1

Cited by 103 publications

(97 citation statements)

References 22 publications

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“…Tor gersen et al [95] also found that corticosteroid treatment increased plasma levels of vasopressin. Some have asked whether there is an inconsistency of the results of the VASST for use of vasopressin versus norepinephrine in less severe and more severe shock subgroups compared to the interaction of vasopressin and corticosteroids.…”

Section: Interactions Of Vasopressin Infusion and Corticosteroid Treamentioning

confidence: 88%

Vasopressin and Its Immune Effects in Septic Shock

Russell

Walley²

2010

J Innate Immun

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clinical studies of vasopressin infusion in septic shock have shown that vasopressin infusion increases blood pressure, decreases requirements for norepinephrine and improves renal function. However, vasopressin could decrease coronary, cerebral and mesenteric perfusion. A multicenter trial of vasopressin versus norepinephrine in septic shock found no overall difference in mortality. Vasopressin may decrease mortality in patients with less severe septic shock. Vasopressin plus corticosteroid treatment may decrease mortality compared to corticosteroids plus norepinephrine. Potential mechanisms are that vasopressin plus corticosteroids beneficially alter immunity in septic shock.

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Section: Interactions Of Vasopressin Infusion and Corticosteroid Treamentioning

confidence: 88%

Vasopressin and Its Immune Effects in Septic Shock

Russell

Walley²

2010

J Innate Immun

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“…Age \18 years, pregnancy, chronic pathologies of the hypothalamic-pituitary-adrenal axis, chronic corticosteroid therapy, duration of AVP infusion \6 h, and AVP therapy for other indications than sepsis related-cardiovascular failure were exclusion criteria. Some patients included in this study have been analysed in previous publications of our working group [1,3,8,9].…”

Section: Methodsmentioning

confidence: 99%

“…All patients were treated according to an institutional haemodynamic protocol that served as a treatment guideline [9]. Patients were routinely monitored with an arterial and central venous line.…”

Section: Haemodynamic Managementmentioning

confidence: 99%

Concomitant arginine-vasopressin and hydrocortisone therapy in severe septic shock: association with mortality

et al. 2011

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Purpose: To evaluate the association between concomitant arginine-vasopressin (AVP)/hydrocortisone therapy and mortality in severe septic shock patients. Methods: This retrospective study included severe septic shock patients treated with supplementary AVP. To test the association between concomitant AVP/hydrocortisone use and mortality, a multivariate regression and Cox model (adjusted for admission year, initial AVP dosage and the Sepsis-related Organ Failure Assessment score before AVP) as well as a propensity score-based analysis were used. In both models, intensive care unit (ICU) and 28-day mortality served as outcome variables. Results: One hundred fifty-nine patients were included. Hydrocortisone was administered to 76 (47.8%) at a median daily dosage of 300 (200-300) mg. In the multivariate logistic regression model, concomitant use of AVP and hydrocortisone was associated with a trend towards lower ICU (OR, 0.51; CI 95%, 0.24-1.08; p = 0.08) and 28-day (HR, 0.69; CI 95%, 0.43-1.08; p = 0.11) mortality. The probability of survival at day 28, as predicted by the regression model, was significantly higher in patients treated with concomitant AVP and hydrocortisone compared to those receiving AVP without hydrocortisone (p = 0.001). In a propensity score-based analysis, ICU (45 vs. 65%; OR, 0.69; CI 95% 0.38-1.26; p = 0.23) and 28-day mortality (35.5 vs. 55%; OR, 0.59; CI 95%, 0.27-1.29; p = 0.18) was not different between patients treated with (n = 40) or without concomitant hydrocortisone (n = 40). Conclusion: Concomitant AVP and hydrocortisone therapy may be associated with a survival benefit in septic shock. An adequately powered, randomised controlled trial appears warranted to confirm these preliminary, hypothesis-generating results.

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“…9 Both AVP and TP have been proven effective in treating sepsis-related hypotension and reducing catecholamine requirements in the experimental 10,11 and clinical 12,13 settings. While TP may hold theoretical and anecdotal advantages over AVP, this has not been formally tested in prospective randomized trials, and its use remains controversial.…”

Section: Casementioning

confidence: 99%

Effects of terlipressin on pulmonary artery pressure in a septic cooled infant: an echocardiographic assessment

2012

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Experience with terlipressin (TP) in the neonatal field is scarce. We describe the effects of TP on pulmonary circulation, studied with echocardiography, in an asphyxiated septic cooled infant with pulmonary hypertension (PH) who developed catecholamine-resistant hypotension and exacerbation of PH shortly after the beginning of the rewarming. TP was added to norephinephine and adrenaline infusions at the dose of 0.02 mg kg À1 every 6 h, because of refractory hypotension and oliguria. After 10 min, blood pressure dramatically and definitely increased, and urinary output was re-established after 60 min. Echocardiographic evaluation 30 min after the second bolus of TP showed unchanged velocity of the tricuspidal valve regurgitation and improved biventricular functional indexes respect to the pre-treatment assessment. TP was continued for 12 h (three doses) without significant adverse effect except for a transient increase in troponin levels. Addition of TP boluses to catecholamine infusion in our newborn was effective in increasing systemic vascular resistance without increasing pulmonary vascular resistance, successfully reversing the hemodynamics of severe PH, and suggesting a potential primary vasodilator effect on pulmonary circulation. Transient increase of troponin levels during TP treatment confirms the risk of excessive coronary vasoconstriction when TP boluses are added to high dose catecholamines.

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Comparing two different arginine vasopressin doses in advanced vasodilatory shock: a randomized, controlled, open-label trial

Abstract: A supplementary AVP infusion of 0.067 IU/min restores cardiovascular function in patients with advanced vasodilatory shock more effectively than AVP at 0.033 IU/min.

Cited by 103 publications

References 22 publications

Vasopressin and Its Immune Effects in Septic Shock

Vasopressin and Its Immune Effects in Septic Shock

Concomitant arginine-vasopressin and hydrocortisone therapy in severe septic shock: association with mortality

Effects of terlipressin on pulmonary artery pressure in a septic cooled infant: an echocardiographic assessment

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