Vasopressin in septic shock: effects on pancreatic, renal, and hepatic blood flow

Krejčí, Vladimír; Hiltebrand, Luzius B.; Jakob, Stephan M.; Takala, Jukka; Sigurðsson, Gísli H.

doi:10.1186/cc6197

Cited by 37 publications

(20 citation statements)

References 43 publications

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“…There is ongoing concern that low-dose vasopressin used to treat septic shock may reduce mesenteric blood flow [54,55] as it does, for example when vasopressin is infused in high doses in the setting of variceal hemorrhage. A range of results are reported in animal models of sepsis and shock [55][56][57][58] , but, overall, vasopressin effects appear to be relatively minimal and hepatosplanchnic microcirculatory flow may also be maintained [58,59] .…”

Section: The Effects Of Vasopressin On Other Organ Dysfunctionmentioning

confidence: 99%

“…A range of results are reported in animal models of sepsis and shock [55][56][57][58] , but, overall, vasopressin effects appear to be relatively minimal and hepatosplanchnic microcirculatory flow may also be maintained [58,59] . Indeed, vasopressin may have a beneficial effect on the gut microcirculation [60] .…”

Section: The Effects Of Vasopressin On Other Organ Dysfunctionmentioning

confidence: 99%

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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: The Effects Of Vasopressin On Other Organ Dysfunctionmentioning

confidence: 99%

Section: The Effects Of Vasopressin On Other Organ Dysfunctionmentioning

confidence: 99%

Vasopressin and Its Immune Effects in Septic Shock

Russell

Walley²

2010

J Innate Immun

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“…Vasopressin significantly decreased superior mesenteric blood flow, which was associated with impaired markers of microcirculation. A recent study by the same group [34] reported in the same experimental model that low-dose (0.06 UI/kg/h) vasopressin also significantly decreased portal venous flow, whereas hepatic artery blood flow remained unaltered. Both studies used models characterized by a hypodynamic circulation, that is, hypotension and depressed CO, which are thus in sharp contrast with the results of the studies in which V1a agonists were assessed in hyperdynamic models that are characterized by a sustained increase in blood flow [32,[35][36][37].…”

Section: Role Of Fluid Resuscitationmentioning

confidence: 78%

The effects of vasopressin and its analogues on the liver and its disorders in the critically ill

Asfar

Radermacher

Calès

et al. 2010

Current Opinion in Critical Care

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The use of vasopressin and its synthetic analogues has shown beneficial effects in the management of patients with cirrhosis, especially in the context of variceal bleeding, the hepatorenal syndrome or both. In both cases, the use of terlipressin improved survival. Therefore, in these clinical indications, terlipressin is a part of recommendations. The role of vasopressin in patients with septic shock remains to be precisely evaluated.

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“…Blood flow was measured by placing the laser Doppler probe on three different areas of the liver surface in the center of the right and the left lobe. Each measurement was recorded for at least 30 s. Care was taken to ensure continuous and steady contact with the tissue under investigation and to prevent motion disturbances from respiration and gastrointestinal peristalsis throughout the experiment [32]. …”

Section: Methodsmentioning

confidence: 99%

Hepatic Arterial Infusion with Tumor Necrosis Factor-α Induces Early Hepatic Hyperperfusion

Schäfer¹,

Sperling²,

Slotta³

et al. 2012

Eur Surg Res

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Background: Hepatic arterial infusion (HAI) has been developed for high-dose regional chemotherapy of unresectable liver metastases or primary liver malignancies. While it is well known that high concentrations of tumor necrosis factor (TNF)-α damage tumor blood perfusion, there is no information on whether autochthonous liver perfusion is affected by HAI with TNF-α. Therefore, we investigated the effects of HAI with TNF-α on hepatic macro- and microvascular perfusion. Methods: Swabian Hall pigs were randomized into three groups. HAI was performed with either 20 or 40 µg/kg body weight TNF-α (n = 6 each group). Saline-treated animals served as controls (n = 6). Analyses during a 2-hour post-HAI observation period included systemic hemodynamics, portal venous and hepatic arterial blood flow, portal venous pressure, and the blood flow in the hepatic microcirculation. Results: HAI with TNF-α caused a slight decrease of mean arterial blood pressure (p < 0.001), which was compensated by a moderate increase of heart rate (p < 0.001). No further systemic side effects of TNF-α were observed. HAI with TNF-α further caused a slight but not significant decrease of portal venous blood flow (p = 0.737) in both experimental groups, paralleled by an increase of hepatic arterial blood flow (p = 0.023, 20 µg/kg; p = 0.034, 40 µg/kg) resulting in an overall hepatic hyperperfusion. The hepatic hyperperfusion after HAI with 20 µg/kg TNF-α was more pronounced and associated with a 40% decrease of the blood flow in the hepatic microcirculation (p = 0.009). HAI with 40 µg/kg TNF-α was only associated with a temporary and moderate total hepatic hyperperfusion and did not affect the blood flow in the hepatic microcirculation. Conclusion: HAI with TNF-α causes a decrease of portal venous flow; however, this is overcompensated by an increased hepatic arterial blood flow, resulting in a total hepatic hyperperfusion. Moderate total hepatic hyperperfusion does not affect the blood flow in the hepatic microcirculation, while a persistent and more pronounced hyperperfusion may cause hepatic microcirculatory disturbances.

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Vasopressin in septic shock: effects on pancreatic, renal, and hepatic blood flow

Cited by 37 publications

References 43 publications

Vasopressin and Its Immune Effects in Septic Shock

Vasopressin and Its Immune Effects in Septic Shock

The effects of vasopressin and its analogues on the liver and its disorders in the critically ill

Hepatic Arterial Infusion with Tumor Necrosis Factor-α Induces Early Hepatic Hyperperfusion

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