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The effect of vasopressin on gastric perfusion in catecholamine-dependent septic shock patients

Introduction

Vasopressin increases blood pressure and decreases catecholamine requirements in septic shock patients [13]. Few clinically relevant data are available on the effect of vasopressin on the splanchnic circulation.

Objective

To study the effect of continuous infusion of vasopressin on the splanchnic circulation in septic shock patients.

Design

Prospective clinical study.

Setting

Intensive care unit in a teaching hospital.

Patients

Eleven consecutive patients with documented septic shock who remained hypotensive despite norepinephrine infusion at a rate of ≥ 0.2 μg/kg per min.

Interventions

Insertion of a gastric tonometry catheter; continuous infusion of vasopressin 0.04 U/min during 4 hours.

Measurements and main results

P(g–a)CO2 gap, blood pressure and cardiac index were recorded at baseline and after 15, 30, 60, 120 and 240 min.

The median P(g–a)CO2 gap increased from 5 mmHg at baseline to 19 mmHg after 4 hours (P = 0.022; Fig. 1). Blood pressure (mean ± SD) increased from 61 ± 13 mmHg at baseline to 68 ± 9 mmHg after 4 hours (P = 0.055). No significant changes in cardiac index were noted (P = 0.978). There was a strong correlation between median plasma levels of vasopressin and the median P(g–a)CO2 gap (r2 = 0.98) as is shown in Fig. 2.

Figure 1
figure 1

Median P(g–a)CO2 gap (mmHg) with 25th and 75th percentiles.

Figure 2
figure 2

Relationship between median plasma levels of vasopressin and median P(g–a)CO2 gap.

Conclusions

In norepinephrine-dependent septic shock patients, continuous infusion of low-dose vasopressin results in a significant and dose-dependent increase of the P(g–a)CO2 gap compatible with gastrointestinal hypoperfusion.

References

  1. Patel BM, Chittock DR, Russell JA, Walley KR: Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 2002, 96: 576-582. 10.1097/00000542-200203000-00011

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  2. Holmes CL, Walley KR, Chittock DR, Lehman T, Russell JA: The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series. Intensive Care Med 2001, 27: 1416-1421. 10.1007/s001340101014

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van Haren, F., Rozendaal, F. & van der Hoeven, J. The effect of vasopressin on gastric perfusion in catecholamine-dependent septic shock patients. Crit Care 7, P047 (2003). https://doi.org/10.1186/cc1936

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  • DOI: https://doi.org/10.1186/cc1936

Keywords

  • Norepinephrine
  • Catecholamine
  • Septic Shock
  • Vasopressin
  • Continuous Infusion