Use of vasopressin in the treatment of refractory septic shock

Abstract

ObjectiveTo evaluate the short-term evolution of patients with septic shock refractory to norepinephrine treated with vasopressin in an intensive care unit of a university hospital.MethodsAn unmatched retrospective study (case series) was performed. Clinical, laboratory, and anthropometric data were collected from patients who received vasopressin infusion for treatment of catecholamine-refractory shock from December 2014 to June 2016. For the assessment of severity, APACHE II and SOFA scores were used. The main outcome was mortality at 3 and 30 days.ResultsA total of 80 patients were included, of which 60% were male. In 86.3% of the cases, APACHE II was observed in the highest ranges (> 20). The 30-day mortality was 86.2%, and 75% of the patients died within 72 hours after starting vasopressin.ConclusionThe series evaluated had high mortality in the first 72 hours of treatment with vasopressin. The use of vasopressin in patients who are refractory to norepinephrine had little or no impact on mortality. It was not possible to exclude the possibility that the high mortality in the present study was linked to the relatively late onset (after established refractoriness of norepinephrine) of vasopressin; this hypothesis should be further evaluated in a randomized study.

Evaluation of vasopressin use in the management of refractory shock in patients admitted to the intensive care unit

“…The high mortality rate that was found (80.8%) is common in refractory shock and corroborates other studies, demonstrating the severity of these cases. Comparatively, in the study by Kny et al 2018, 75% of deaths were observed within 72 hours and 86.2% within 30 days, in 80 cases of refractory septic shock, the majority with a hospital stay of up to 10 days (Kny et al, 2018).…”

Efficacy and Safety of Vasopressin Alone or in Combination With Catecholamines in the Treatment of Septic Shock: A Systematic Review

“…Role and adverse effects of VP are described in detail in the text [22][23][24][25][26][27][28][29][30][31][32][33].…”

“…According to a study by Kny et al [ 27 ], VP usage may raise blood pressure and decrease the need for catecholamines in septic shock patients who are resistant to intravenous fluids and other treatments; leading to an indirect reduction in the detrimental effects of catecholamines on renal failure and arrhythmias [ 27 ]. The reason not to use NE in higher doses might be the insensitivity of adrenergic receptors in patients with septic shock which diverts NE to work on nonspecific loci leading to adverse effects such as undesirable hemodynamic effects, also enhanced coagulation, reduced innate and adaptive immunity, and increased bacterial replication and virulence [ 22 ].…”

The Need for Hemodynamic Support of Patients with Sepsis

“…P <0,05 değeri istatistiksel açıdan anlamlı kabul edildi. (13,17). Sepsisteki yüksek ölüm hızı, tedavi kalitesi ve hastalığın karmaşık yapısı ile ilgilidir (15).…”

“…Bu nedenle septik şoklu hastalarda perfüzyonun arttırılması, mikro dolaşımın izlenmesi ve yönetilmesi önemlidir (18). Bu amaçla, septik hastalarda, kan basıncını yeniden sağlamak ve organ işlevini düzeltmek için hacim genişlemesi yeterli olmadığında inotrop desteği yapılmalıdır (13,14,16). Ayrıca, sepsisteki hastalarda yakın şok takibi, şokun erken tanısı ve tedavisi için bazı parametrelere ihtiyaç vardır.…”