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Arginine vasopressin: The future of pressure-support resuscitation in hemorrhagic shock.
MedLine Citation:
PMID:  22480832     Owner:  NLM     Status:  Publisher    
BACKGROUND: Arginine vasopressin (AVP) is a key player in maintaining the intravascular volume and pressure during hemorrhagic shock. During the past 2 decades, animal studies, case reports, and reviews have documented the minimized blood loss and improved perfusion pressures in those receiving pressure support with AVP. MATERIALS AND METHODS: A PubMed search of studies was conducted with the terms: "AVP," "arginine vasopressin," "antidiuretic hormone," "hemorrhagic shock," "hemorrhage," "circulatory shock," "fluid resuscitation," "trauma," "massive transfusion protocol," "physiology," "cerebral," "renal," "cardiac," "perfusion," "dose," and "hypotension." The studies were located by a search of a combination of these terms. Also, within-PubMed citations relating to the studies gathered from the initial search were explored. Reports discussing vasopressin in hemorrhagic states were considered. No predetermined limit was used to choose or exclude articles. RESULTS: AVP is an important hormone in osmoregulation and blood pressure. During stress, such as hemorrhage, the levels have been shown to rapidly decrease. Furthermore numerous animal studies and limited human studies have shown that circulatory support with AVP is linked to improved outcomes. No large human prospective studies are available to guide its use at present, but some of its effectiveness seems to lie in its ability to increase calcium sensitivity in acidotic environs, thereby allowing for more effective maintenance of vascular tone than catecholamines. It also redirects blood from the periphery, creating a steal syndrome, and increases the oxygen supply to vital organs, minimizing blood loss, and allowing additional time for surgical repair. CONCLUSIONS: With these encouraging data, there is hope that "pressure support" will be the "resuscitation" considered necessary for a patient's optimum survival.
Tanya Anand; Ruby Skinner
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-17
Journal Detail:
Title:  The Journal of surgical research     Volume:  -     ISSN:  1095-8673     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-4-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376340     Medline TA:  J Surg Res     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Department of Surgery, Division of Trauma and Surgical Critical Care, Kern Medical Center, Bakersfield, CA.
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