Arginine vasopressin in 316 patients with advanced vasodilatory shock*
- 1 November 2005
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 33 (11), 2659-2666
- https://doi.org/10.1097/01.ccm.0000186749.34028.40
Abstract
To assess the effects of arginine vasopressin (AVP) on hemodynamic, clinical, and laboratory variables and to determine its adverse side effects in advanced vasodilatory shock. Retrospective study. A total of 316 patients. AVP infusion (4 units/hr). Cardiocirculatory, laboratory, and clinical variables were evaluated before, 0.5, 1, 4, 12, 24, 48, and 72 hrs after administration of AVP. AVP increased mean arterial pressure, systemic vascular resistance, and stroke volume index. Heart rate, central venous pressure, mean pulmonary arterial pressure, norepinephrine, milrinone, and epinephrine requirements decreased. There was no difference in the hemodynamic response between patients with septic shock, postcardiotomy shock, or systemic inflammatory response syndrome. Cardiac index decreased in 41.1% of patients during AVP treatment. In patients with hyperdynamic circulation before AVP, cardiac index decreased, whereas it remained uncharged or tended to increase in patients with normodynamic or hypodynamic circulation. During the course of AVP treatment, liver enzymes (28.5% of patients) and total bilirubin concentrations (69.3% of patients) increased, whereas platelet count decreased (73.4% of patients). Simultaneous hemofiltration significantly contributed to the decrease in platelet count (p < .001) and increase in bilirubin (p < .001). Whereas patients with an increase in bilirubin were more likely to die, a decrease in cardiac index or platelet count and an increase in liver enzymes did not affect mortality. Systemic inflammatory response syndrome as admission diagnosis, a high degree of multiple organ dysfunction, and norepinephrine requirements of >0.5 μg·kg−1·min−1 before AVP treatment were independent risk factors for death from advanced vasodilatory shock treated with AVP. If norepinephrine dosages exceeded 0.6 μg·kg−1·min−1 before AVP treatment, a substantial increase in mortality occurred. Supplementary AVP infusion improved cardiocirculatory function in advanced vasodilatory shock, but an increase in liver enzymes and bilirubin, and a decrease in platelet count occurred during AVP therapy, particularly during simultaneous hemofiltration. Initiation of AVP infusion before norepinephrine requirements exceeding 0.6 μg·kg−1·min−1 may improve outcome.Keywords
This publication has 34 references indexed in Scilit:
- A Comparison of Vasopressin and Epinephrine for Out-of-Hospital Cardiopulmonary ResuscitationThe New England Journal of Medicine, 2004
- Science Review: Vasopressin and the cardiovascular system part 2 – clinical physiologyCritical Care, 2004
- Arginine Vasopressin in Advanced Vasodilatory ShockCirculation, 2003
- Cardiovascular management of septic shockCritical Care Medicine, 2003
- Management of Vasodilatory ShockDrugs, 2003
- Vasopressin: New Uses in Critical CareThe American Journal of the Medical Sciences, 2002
- Beneficial Effects of Short-term Vasopressin Infusion during Severe Septic ShockAnesthesiology, 2002
- The Pathogenesis of Vasodilatory ShockThe New England Journal of Medicine, 2001
- Pathogenetic Mechanisms of Septic ShockThe New England Journal of Medicine, 1993
- American College of Chest Physicians/Society of Critical Care Medicine Consensus ConferenceCritical Care Medicine, 1992