Vasopressin and Its Immune Effects in Septic Shock

Russell, James A.; Walley, Keith R.

doi:10.1159/000318531

Cited by 62 publications

(35 citation statements)

References 210 publications

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“…The associated increase in urine output and natriuresis demonstrated use has also been described previously and is thought to result from the increased renal perfusion pressure (24,25). Increased urinary sodium excretion has been described extensively in experimental animal studies (26,27,28) and is likely due to a shift from the V2 receptor mediated effects on water permeability towards the V1a natriuretic effects with higher levels of vasopressin exposure, as seen in patients receiving an exogenous vasopressin infusion (29).…”

Section: Discussionsupporting

confidence: 69%

Vasopressin Improves Hemodynamic Status in Infants with Congenital Diaphragmatic Hernia

Acker

Kinsella

Abman

et al. 2014

The Journal of Pediatrics

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Objective To assess the ability of vasopressin to stabilize hemodynamics in infants with systemic hypotension secondary to congenital diaphragmatic hernia (CDH). Study design A retrospective chart review was performed to identify 13 patients with CDH treated with vasopressin for refractory hypotension, to assess the effect of vasopressin on pulmonary and systemic hemodynamics and gas exchange in this setting. Data collected included demographics, respiratory support, inotropic agents, pulmonary and systemic hemodynamics, urine output, and serum and urine sodium levels during vasopressin therapy. Results Vasopressin therapy increased mean arterial pressure and decreased pulmonary: systemic pressure ratio, heart rate and FiO2. In 6 of 13 patients, ECMO was no longer indicated after vasopressin treatment. Improvement in left ventricular (LV) function and oxygenation index after vasopressin initiation were associated with a decreased need for ECMO. Prolonged vasopressin treatment was associated with hyponatremia, increased urine output and increased urine sodium. Conclusions Vasopressin stabilized systemic hemodynamics without adverse effects on pulmonary hemodynamics in a subset of infants with CDH. Our results suggest a potential role for vasopressin therapy in patients with CDH with catecholamine resistant refractory hypotension.

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Section: Discussionsupporting

confidence: 69%

Vasopressin Improves Hemodynamic Status in Infants with Congenital Diaphragmatic Hernia

Acker

Kinsella

Abman

et al. 2014

The Journal of Pediatrics

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“…The lower intestinal concentration of IL-6 observed in the AVP group suggested protective effects of the combination therapy. The result was supported by other studies on IL-6 production (15), in which it was found that AVP reduced the IL-6 concentration in response to the endotoxin stimulus. Moreover, it has been shown that increased inducible nitric oxide synthase-dependent nitride oxide production decreases the expression of tight junction proteins and tight junction localization in endotoxemia mice (16).…”

Section: Discussionsupporting

confidence: 82%

Experimental sepsis in pigs—effects of vasopressin on renal, hepatic, and intestinal dysfunction

Yang

et al. 2012

Upsala Journal of Medical Sciences

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IntroductionLow-dose arginine vasopressin (AVP) has been proposed as an adjunctive vasopressor for the treatment of advanced vasodilatory shock. However, its effects on renal, hepatic, and intestinal dysfunction during sepsis remain controversial.MethodsFecal peritonitis was induced in 20 anesthetized, invasively monitored, mechanically ventilated female pigs. Following the time point of septic shock (defined as mean artery pressure (MAP) ≤65 mmHg), animals were randomly assigned to the following groups (n = 10): 1) a norepinephrine group with MAP between 65 and 75 mmHg; and 2) an AVP group with a constant infusion rate of 0.5 mU.kg-1.min-1.ResultsMAP, pulmonary capillary wedge pressure, hematocrit, TNF-α, IL-6, and IL-10 were similar in the two groups during the 28-h observation period. Infusion of AVP was associated with lower total norepinephrine and fluid requirements. There was a statistically significant improvement in renal function as assessed by increased urine output and renal blood flow, and decreased serum creatinine, in the AVP group when compared with the norepinephrine group (P < 0.05). Histological analyses of the intestine, liver, and kidney showed similar light microscopical appearance of the two groups. Apoptotic cells in the liver were significantly fewer in the AVP group when compared with the norepinephrine group (P < 0.05).ConclusionAn adjunctive AVP to norepinephrine infusion exhibits a favorable impact on renal function without deleterious effects on the liver and intestine in a porcine model of experimental sepsis when compared with norepinephrine infusion alone.

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“…Pregnancy mechanisms that mediate preeclampsia such as immune dysfunction, endothelial and vascular dysfunction, oxidative stress, and angiogenesis 33 , must be initiated by an earlier event or signal. AVP is known to interact with essentially all of these processes 34,35 . Therefore, we contend that AVP hypersecretion represents an initiating event / signal (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

Vasopressin in Preeclampsia

et al. 2014

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Preeclampsia, a cardiovascular disorder of late pregnancy, is characterized as a low-renin hypertensive state relative to normotensive pregnancy. As other non-pregnant low-renin hypertensive disorders often exhibit and are occasionally dependent upon elevated arginine vasopressin (AVP) secretion, we hypothesized a possible use for plasma AVP measurements in the prediction of preeclampsia. Copeptin is an inert pro-segment of AVP that is secreted in a 1:1 molar ratio and exhibits a substantially longer biological half-life than AVP, rendering it a clinically useful biomarker of AVP secretion. Copeptin was measured throughout pregnancy in maternal plasma from preeclamptic and control women. Maternal plasma copeptin was significantly higher throughout preeclamptic pregnancies versus control pregnancies. While controlling for clinically significant confounders (age, BMI, chronic essential hypertension, twin gestation, diabetes, and history of preeclampsia) using multivariate regression, the association of higher copeptin concentration and the development of preeclampsia remained significant. Receiver operating characteristic analyses reveal that as early as the 6th week of gestation, elevated maternal plasma copeptin concentration is a highly significant predictor of preeclampsia throughout pregnancy. Finally, chronic infusion of AVP during pregnancy (24 ng/hr) is sufficient to phenocopy preeclampsia in C57BL/6J mice, causing pregnancy-specific hypertension, renal glomerular endotheliosis, proteinuria, and intrauterine growth restriction. These data (1) implicate AVP release as a novel predictive biomarker for preeclampsia very early in pregnancy, (2) identify chronic AVP infusion as a novel and clinically-relevant model of preeclampsia in mice, and are (3) consistent with a potential causative role for AVP in preeclampsia in humans.

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Vasopressin and Its Immune Effects in Septic Shock

Cited by 62 publications

References 210 publications

Vasopressin Improves Hemodynamic Status in Infants with Congenital Diaphragmatic Hernia

Vasopressin Improves Hemodynamic Status in Infants with Congenital Diaphragmatic Hernia

Experimental sepsis in pigs—effects of vasopressin on renal, hepatic, and intestinal dysfunction

Vasopressin in Preeclampsia

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