Review article: Organ per fusion/permeabilityrelated effects of norepinephrine and vasopressin in sepsis

Abstract

Purpose:One invariable hallmark of severe sepsis is generalized tissue "malperfusion" and hyperpermeability secondary to microcirculatory/capillary leakage. This review focuses on direct and/or indirect influences of norepinephrine, as a standard of care, and vasopressin, as an alternative vasoactive drug, on organ and tissue perfusion/permeability in severe sepsis.Source: English and French language articles and books published between 1966 and 2005 were identified through a computerized Medline search using the terms "sepsis, permeability, norepinephrine and vasopressin". Relevant publications were retrieved and scanned for additional sources. Principal findings:There are few randomized clinical trials comparing different vasopressors in sepsis; most available literature consists of clinical reports, animal experiments and occasional reviews. Based on the best current evidence from these sources, we describe the status of major organ perfusion/ permeability in sepsis (i.e., the lung, the kidney, the heart, the intestine/gut) in the context of sepsis-induced organ dysfunction/failure. Potential and differential therapeutic effects of the vasopressors norepinephrine and arginine-vasopressin, in the setting of sepsis, are identified. Conclusions:In the treatment of sepsis, arginine-vasopressin exhibits organ-specific heterogeneity in vascular responsiveness, compared to norepinephrine. While norepinephrine is a current standard of care in sepsis, arginine-vasopressin shows promise for the treatment of septic shock. Objectif

Effects of two different dosing regimens of terlipressin on organ functions in ovine endotoxemia

“…Besides excessive vasodilation and cardiac depression, severe endothelial dysfunction represents another hallmark of sepsis, resulting in microvascular hyperpermeability and transvascular flux of fluids and proteins [28]. This condition is typically associated with significant formation of edema and may even be a contributor to increased mortality in critically ill patients [29].…”

Vasopressin Increases Cerebral Perfusion Pressure but not Cerebral Blood Flow in Neurosurgical Patients with Catecholamine-Refractory Hypotension: A Preliminary Evaluation Using the Non-Invasive Quantix ND in Comparison to the Literature

“…But with increasing dosage or prolonged duration, side effects like increased heart rate and increased myocardial oxygen consumption occur. The elevation of systemic vascular resistance can also compromise end organ perfusion [2,3]. In addition refractoriness to catecholamines exists [4].…”

Hypothalamic–pituitary–adrenal axis multiple and organ dysfunction syndrome in critical illness: A special focus on arginine-vasopressin and apelin

“…Moreover, because splanchnic blood flow, being a non-critical organ bed, is not protected, gastrointestinal blood flow has been reported to be susceptible to AVP (90,91), although this was not confirmed in two prospective controlled studies (3,59), and bowel necrosis was rarely reported. Dose-independent coronary spasms or vasoconstriction inducing diastolic heart dysfunction, as well as dose-dependent negative inotropic effects, have occasionally been observed with AVP infusion (37,51,59,92,93). Increases in liver enzymes and bilirubin concentrations during sepsis and post-CBG shock can also occur with AVP administration (84).…”