Document Detail


Arginine vasopressin as a supplementary vasopressor in refractory hypertensive, hypervolemic, hemodilutional therapy in subarachnoid hemorrhage.
MedLine Citation:
PMID:  17356185     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Hypertensive, hypervolemic, and hemodilutional (HHH) therapy for vasospasm in subarachnoid hemorrhage (SAH) refractory to phenylephrine requires high doses of catecholamines, leading to adverse adrenergic effects. Arginine vasopressin (AVP) has been shown to stabilize advanced shock states while facilitating reduction of catecholamine doses, but its use has never been reported in SAH. In this retrospective study, we investigated the hemodynamic effects and feasibility of supplementary AVP in refractory HHH therapy in SAH. METHODS: Hemodynamic response (mean arterial pressure [MAP], heart rate, central venous pressure, cardiac index, systemic vascular resistance index, and end diastolic volume index) to a supplementary AVP infusion (0.01-0.04 IU/minute) was recorded within the first 24 hours in 22 patients. Secondary endpoints (serum sodium concentration, incidence of vasospasm, and intracranial pressure [ICP]) were compared to controls on HHH therapy with phenylephrine alone. RESULTS: After initiation of AVP, MAP increased significantly compared to baseline. Phenylephrine doses decreased significantly, whereas other hemodynamic parameters remained stable. Serum sodium concentrations decreased similarly in both groups (-5 +/- 7 mmol/L versus -6 +/- 4 mmol/L; p = 0.25). No detrimental effects on vasospasm incidence or ICP and cerebral perfusion pressure were noted. CONCLUSION: AVP may be considered as an alternative supplementary vasopressor in refractory HHH therapy with phenylephrine in SAH. Although we did not observe any deleterious effect of AVP on cerebral circulation, close observation for development of cerebral vasospasm should be undertaken, until it is clearly demonstrated that AVP has no adverse effects on regional cerebral blood flow and symptomatic cerebral vasospasm. Our limited data suggest that low-dose AVP does not cause brain edema, but further study is merited.
Authors:
Susanne Muehlschlegel; Martin W Dunser; Andrea Gabrielli; Volker Wenzel; A Joseph Layon
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Neurocritical care     Volume:  6     ISSN:  1541-6933     ISO Abbreviation:  Neurocrit Care     Publication Date:  2007  
Date Detail:
Created Date:  2007-03-14     Completed Date:  2007-09-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3-10     Citation Subset:  IM    
Affiliation:
Division of Vascular Neurology and Neurocritical Care, Department of Neurology, Massachusetts General Hospital/Brigham Women's Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. smuehlschlegel@partners.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Antihypertensive Agents / therapeutic use*
Arginine Vasopressin / administration & dosage,  therapeutic use*
Blood Volume / drug effects,  physiology*
Cerebrovascular Circulation / drug effects
Female
Hemodilution / methods
Humans
Infusions, Intravenous
Intracranial Aneurysm / drug therapy
Intracranial Pressure / drug effects,  physiology
Male
Middle Aged
Subarachnoid Hemorrhage / drug therapy*
Vasoconstrictor Agents / administration & dosage,  therapeutic use*
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Vasoconstrictor Agents; 113-79-1/Arginine Vasopressin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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