Heterogeneity of the vasoconstrictor effect of vasopressin in septic shock - PubMed (original) (raw)
Heterogeneity of the vasoconstrictor effect of vasopressin in septic shock
Mary-Beth Malay et al. Crit Care Med. 2004 Jun.
Abstract
Objective: To determine whether pressor doses of vasopressin impair organ blood flow in endotoxic shock.
Design: Graded doses of vasopressin or phenylephrine, starting at the clinically recommended doses for pressure support in septic shock, were intravenously infused during endotoxic shock.
Setting: University hospital surgical research laboratory.
Subjects: Twelve random-bred female Yorkshire pigs.
Interventions: We measured mean arterial pressure, cardiac output, heart rate, pulmonary artery occlusion pressure, and carotid, mesenteric, renal, and iliac blood flows.
Measurements and main results: Low doses of vasopressin (typically used in the clinical management of septic shock) raised arterial pressure by increasing systemic vascular resistance without a significant preferential effect in the circulations measured. However, moderately greater doses of vasopressin had a very heterogeneous vasoconstrictor action; although there was no significant vasoconstriction in the carotid and iliac circulations, mesenteric and renal blood flows decreased markedly. Furthermore, at pressor doses vasopressin improved cerebral perfusion.
Conclusions: The vasoconstrictor action of exogenous low-dose vasopressin in endotoxic shock does not impair blood flow to any of the vascular beds examined. However, moderately higher doses of vasopressin may induce ischemia in the mesenteric and renal circulations. The data indicate that the safe dose range for exogenous vasopressin in septic shock is narrow and support the current practice of fixed low-dose administration, generally 0.04 units/min and in no case exceeding 0.1 units/min.
Comment in
- Vasopressin in septic shock: does dose matter?
Holmes CL. Holmes CL. Crit Care Med. 2004 Jun;32(6):1423-4. doi: 10.1097/01.ccm.0000126377.73419.b9. Crit Care Med. 2004. PMID: 15187536 No abstract available.
Similar articles
- Effects of vasopressin on microcirculatory blood flow in the gastrointestinal tract in anesthetized pigs in septic shock.
Hiltebrand LB, Krejci V, Jakob SM, Takala J, Sigurdsson GH. Hiltebrand LB, et al. Anesthesiology. 2007 Jun;106(6):1156-67. doi: 10.1097/01.anes.0000267599.02140.86. Anesthesiology. 2007. PMID: 17525591 - Low-dose vasopressin in the treatment of vasodilatory septic shock.
Malay MB, Ashton RC Jr, Landry DW, Townsend RN. Malay MB, et al. J Trauma. 1999 Oct;47(4):699-703; discussion 703-5. doi: 10.1097/00005373-199910000-00014. J Trauma. 1999. PMID: 10528604 Clinical Trial. - Decreased vasopressin responsiveness in vasodilatory septic shock-like conditions.
Leone M, Boyle WA. Leone M, et al. Crit Care Med. 2006 Apr;34(4):1126-30. doi: 10.1097/01.CCM.0000206466.56669.BE. Crit Care Med. 2006. PMID: 16484914 - Clinical review: Vasopressin and terlipressin in septic shock patients.
Delmas A, Leone M, Rousseau S, Albanèse J, Martin C. Delmas A, et al. Crit Care. 2005 Apr;9(2):212-22. doi: 10.1186/cc2945. Epub 2004 Sep 9. Crit Care. 2005. PMID: 15774080 Free PMC article. Review. - Role of vasopressin in the management of septic shock.
Mutlu GM, Factor P. Mutlu GM, et al. Intensive Care Med. 2004 Jul;30(7):1276-91. doi: 10.1007/s00134-004-2283-8. Epub 2004 Apr 21. Intensive Care Med. 2004. PMID: 15103461 Review.
Cited by
- Vasopressin treatment of verapamil toxicity in the porcine model.
Barry JD, Durkovich D, Cantrell L, Richardson W, Tong T, Offerman S, Clark RF, Tanen DA, Williams S. Barry JD, et al. J Med Toxicol. 2005 Dec;1(1):3-10. doi: 10.1007/BF03160898. J Med Toxicol. 2005. PMID: 18072096 Free PMC article. - Systemic and hepatosplanchnic macro- and microcirculatory dose response to arginine vasopressin in endotoxic rabbits.
Kopel T, Losser MR, Faivre V, Payen D. Kopel T, et al. Intensive Care Med. 2008 Jul;34(7):1313-20. doi: 10.1007/s00134-008-1058-z. Epub 2008 Mar 26. Intensive Care Med. 2008. PMID: 18365175 - Vasopressor hormones in shock-noradrenaline, vasopressin or angiotensin II: which one will make the race?
Dünser MW, Meier J. Dünser MW, et al. J Thorac Dis. 2017 Jul;9(7):1843-1847. doi: 10.21037/jtd.2017.06.127. J Thorac Dis. 2017. PMID: 28839980 Free PMC article. No abstract available. - Hepatorenal syndrome.
Sandhu BS, Sanyal AJ. Sandhu BS, et al. Curr Treat Options Gastroenterol. 2005 Dec;8(6):443-50. doi: 10.1007/s11938-005-0030-z. Curr Treat Options Gastroenterol. 2005. PMID: 16313861 - Vasopressin in vasodilatory shock: hemodynamic stabilization at the cost of the liver and the kidney?
Bracht H, Asfar P, Radermacher P, Calzia E. Bracht H, et al. Crit Care. 2007;11(6):178. doi: 10.1186/cc6171. Crit Care. 2007. PMID: 18177510 Free PMC article. Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources