Document Detail


The role of vasopressin in vasodilatory septic shock.
MedLine Citation:
PMID:  15338853     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Septic shock that requires therapy with adrenergic agents is associated with high rates of mortality. Inappropriately normal or low serum concentrations of vasopressin contribute to the development of hypotension during sepsis. We critically evaluated the role of administering exogenous vasopressin to patients with septic shock. A computerized search of MEDLINE from January 1966--December 2003 and a manual search of relevant journals for abstracts were conducted. Eleven retrospective, six prospective cohort, and four prospective randomized studies were identified. Most studies evaluated short-term infusions of vasopressin at 0.08 U/minute or less as add-on therapy in patients requiring adrenergic agents. The results show that starting vasopressin in patients with septic shock increases systemic vascular resistance and arterial blood pressure, thus reducing the dosage requirements of adrenergic agents. These effects are rapid and sustained. Substantial enhancement of urine production, likely due to increased glomerular filtration rate, was shown in several studies. A few studies demonstrated clinically significant reduced cardiac output or cardiac index after vasopressin was begun, necessitating cautious use in patients with cardiac dysfunction. Vasopressin was associated with ischemia of the mesenteric mucosa, skin, and myocardium; elevated hepatic transaminase and bilirubin concentrations; hyponatremia; and thrombocytopenia. Limiting the dosage to 0.03 U/minut or less may minimize the development of these adverse effects. Vasopressin 0.03 U/minute or less should be considered if response to one or two adrenergic agents is inadequate or as a method to reduce the dosage of adrenergic agents. At present, vasopressin therapy should not be started as first-line therapy. Additional studies are needed to determine the optimum dosage, duration, and place in therapy of vasopressin relative to adrenergic agents. A multicenter, comparative study of vasopressin 0.03 U/minute as add-on therapy is under way and should provide mortality data.
Authors:
Marilee D Obritsch; Daniel J Bestul; Rose Jung; Douglas N Fish; Robert MacLaren
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Pharmacotherapy     Volume:  24     ISSN:  0277-0008     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-09-01     Completed Date:  2004-10-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1050-63     Citation Subset:  IM    
Affiliation:
Department of Pharmacy, University of Colorado Hospital, Denver, Colorado, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Pressure / drug effects
Critical Care
Humans
Randomized Controlled Trials as Topic
Retrospective Studies
Shock, Septic / drug therapy*,  mortality,  physiopathology
Skin Diseases / chemically induced
Vasoconstrictor Agents / adverse effects,  blood,  therapeutic use*
Vasopressins / adverse effects,  blood,  therapeutic use*
Chemical
Reg. No./Substance:
0/Vasoconstrictor Agents; 11000-17-2/Vasopressins

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


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