The role of vasopressin in cardiorespiratory arrest and pulmonary hypertension

Smith, A.; Elliot, CA; Kiely, David G.; Channer, KS

doi:10.1093/qjmed/hcl009

Cited by 33 publications

(14 citation statements)

References 32 publications

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“…This property manifests clinically as a reduction in PVR and PVR/SVR ratio [105,115,116]. AVP has also been used as a rescue therapy in patients during PH crises [117-119], in which untreated equalization of systemic and pulmonary pressures may be rapidly fatal. At low doses (0.03-0.067 U/min), it has been used safely in sepsis [105,120-124], as well as in patients with acute PH and RV failure with hypotension after cardiac surgery [115,116,125,126] and hypotension associated with chronic PH in several settings [117,118,127,128].…”

Section: Resultsmentioning

confidence: 99%

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

et al. 2010

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IntroductionPulmonary vascular dysfunction, pulmonary hypertension (PH), and resulting right ventricular (RV) failure occur in many critical illnesses and may be associated with a worse prognosis. PH and RV failure may be difficult to manage: principles include maintenance of appropriate RV preload, augmentation of RV function, and reduction of RV afterload by lowering pulmonary vascular resistance (PVR). We therefore provide a detailed update on the management of PH and RV failure in adult critical care.MethodsA systematic review was performed, based on a search of the literature from 1980 to 2010, by using prespecified search terms. Relevant studies were subjected to analysis based on the GRADE method.ResultsClinical studies of intensive care management of pulmonary vascular dysfunction were identified, describing volume therapy, vasopressors, sympathetic inotropes, inodilators, levosimendan, pulmonary vasodilators, and mechanical devices. The following GRADE recommendations (evidence level) are made in patients with pulmonary vascular dysfunction: 1) A weak recommendation (very-low-quality evidence) is made that close monitoring of the RV is advised as volume loading may worsen RV performance; 2) A weak recommendation (low-quality evidence) is made that low-dose norepinephrine is an effective pressor in these patients; and that 3) low-dose vasopressin may be useful to manage patients with resistant vasodilatory shock. 4) A weak recommendation (low-moderate quality evidence) is made that low-dose dobutamine improves RV function in pulmonary vascular dysfunction. 5) A strong recommendation (moderate-quality evidence) is made that phosphodiesterase type III inhibitors reduce PVR and improve RV function, although hypotension is frequent. 6) A weak recommendation (low-quality evidence) is made that levosimendan may be useful for short-term improvements in RV performance. 7) A strong recommendation (moderate-quality evidence) is made that pulmonary vasodilators reduce PVR and improve RV function, notably in pulmonary vascular dysfunction after cardiac surgery, and that the side-effect profile is reduced by using inhaled rather than systemic agents. 8) A weak recommendation (very-low-quality evidence) is made that mechanical therapies may be useful rescue therapies in some settings of pulmonary vascular dysfunction awaiting definitive therapy.ConclusionsThis systematic review highlights that although some recommendations can be made to guide the critical care management of pulmonary vascular and right ventricular dysfunction, within the limitations of this review and the GRADE methodology, the quality of the evidence base is generally low, and further high-quality research is needed.

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Section: Resultsmentioning

confidence: 99%

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

et al. 2010

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“…2,6,9,65,92 Vasopressin may produce endothelium-dependent pulmonary vasodilation to slightly reduce PVR while increasing SVR, making this drug useful when SVR is low in patients with RVF. 2,6,9,[85][86][87]93,94 Norepinephrine is our first-line vasopressor for patients with severe hypotension, and we often add vasopressin based on its slight PVR lowering and lack of tachycardic effects. 2,3,5,6,8,9,34,94 Dopamine can be useful for vasopressor support due to its positive inotropic effects, despite an increased risk of tachyarrhythmias and less effective MAP augmentation than norepinephrine.…”

Section: Treatment Of Rvfmentioning

confidence: 99%

Pulmonary Hypertension in the Intensive Care Unit

Jentzer

Mathier

2015

J Intensive Care Med

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Pulmonary hypertension occurs as the result of disease processes increasing pressure within the pulmonary circulation, eventually leading to right ventricular failure. Patients may become critically ill from complications of pulmonary hypertension and right ventricular failure or may develop pulmonary hypertension as the result of critical illness. Diagnostic testing should evaluate for common causes such as left heart failure, hypoxemic lung disease and pulmonary embolism. Relatively few patients with pulmonary hypertension encountered in clinical practice require specific pharmacologic treatment of pulmonary hypertension targeting the pulmonary vasculature. Management of right ventricular failure involves optimization of preload, maintenance of systemic blood pressure and augmentation of inotropy to restore systemic perfusion. Selected patients may require pharmacologic therapy to reduce right ventricular afterload by directly targeting the pulmonary vasculature, but only after excluding elevated left heart filling pressures and confirming increased pulmonary vascular resistance. Critically-ill patients with pulmonary hypertension remain at high risk of adverse outcomes, requiring a diligent and thoughtful approach to diagnosis and treatment.

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“…It induces systemic vasoconstriction and this effect led to its therapeutic use in clinical conditions where reduced systemic vascular resistance is a concern, such as septic shock (1, 2). Yet, vasopressin has also been shown to reduce pulmonary vascular resistance in human and animals (3–6) leading to its use in the treatment of pulmonary arterial hypertension in adults (3, 4). A recent review of the available clinical literature did not find sufficient evidence to recommend vasopressin as a pulmonary vasodilator in adults (7).…”

Section: Introductionmentioning

confidence: 99%

Age dependency of vasopressin pulmonary vasodilatory effect in rats

et al. 2013

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BackgroundVasopressin is a systemic vasoconstrictor. Its pulmonary vasodilatory effect is controversial and limited data are available on its use in neonates with pulmonary hypertension. Hypothesizing that the vasopressin-induced pulmonary vasodilation is developmentally regulated, we evaluated its pulmonary and systemic arterial response in newborn and adult rats.MethodsVessels were mounted on a wire myograph and the vasopressin-induced changes in vasomotor tone measured. The vessel- and age-dependent differences in vasopressin V1a and V2 receptors expression were evaluated by Western blotting.ResultsVasopressin induced a dose-dependent increase in mesenteric arterial tone at both ages, but of greater magnitude in adult vessels (P<0.01). At lower concentrations, vasopressin induced pulmonary vasodilation in adult vessels and vasoconstriction in newborn arteries. The adult vasopressin-induced pulmonary vasodilation was inhibited by ibuprofen suggesting that the response is prostaglandin mediated. Pulmonary tissue V1a receptor protein expression was higher in adult, when compared with newborn arteries (P<0.01). The adult vessels V1a expression predominated in the pulmonary arteries and V2 was only detected in mesenteric arteries.ConclusionThe vasopressin-induced pulmonary vasodilation is absent in newborn rats likely due to the lower tissue V1a expression early in life. These animal data challenge the therapeutic use of vasopressin in neonatal pulmonary hypertension.

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The role of vasopressin in cardiorespiratory arrest and pulmonary hypertension

Cited by 33 publications

References 32 publications

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

Pulmonary Hypertension in the Intensive Care Unit

Age dependency of vasopressin pulmonary vasodilatory effect in rats

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