Rebound hypotension following terlipressin bolus infusion can be prevented by continuous low-dose infusion of terlipressin

Introduction

Bolus infusion of terlipressin, a vasopressin analog, increases the mean arterial pressure (MAP) in patients with sepsis-related arterial hypotension. However, bolus infusion of terlipressin may be associated with severe side effects like excessive systemic and pulmonary vasoconstriction. We hypothesized that continuous low-dose infusion of terlipressin may reverse arterial hypotension with reduced side effects.

Methods

Sixteen ewes were chronically instrumented to determine the hemodynamics of the systemic and pulmonary circulation. After 16 hours of endotoxin infusion, all sheep exhibited a hypotensive–hyperdynamic circulation. Thereafter, the animals were randomized to be treated with either a continuous (2 mg over 24 hours) or bolus infusion (1 mg every 6 hours) of terlipressin.

Results

Continuous infusion of terlipressin reversed the endotoxin-induced decrease in MAP during the entire 24-hour study period (P < 0.001). Intermittent bolus injections of terlipressin contributed to overshooting increases in MAP, as well as in systemic and pulmonary vascular resistance index (each P < 0.001), which were followed by sudden and strong rebound effects (Figure 1).

Figure 1

Mean arterial pressure (MAP) during continuous and intermittent bolus infusion of terlipressin in endotexemic ewes.

Conclusion

A goal-directed continuous infusion of terlipressin may be superior to terlipressin bolus injection to treat patients with sepsis-related arterial hypotension.