Continuous terlipressin versus vasopressin infusion in septic shock: the TERLIVAP study

Introduction

The results of the Vasopressin in Septic Shock Trial suggest that early administration of vasopressin may be superior to a last resort treatment. However, it is still unknown whether vasopressin is superior to terlipressin. We therefore performed a randomized study to compare the efficacy and safety of continuous infusions of either vasopressin or terlipressin as first-line therapy in patients with septic shock.

Methods

We enrolled 45 septic shock patients requiring vasopressor support to maintain mean arterial pressure between 65 and 75 mmHg despite adequate volume resuscitation. Patients were randomly allocated to be treated either with a continuous terlipressin infusion (1.3 μg/kg/hour), with vasopressin (0.03 U/min), or with titrated norepinephrine (control; each n = 15). In both the terlipressin and vasopressin groups, norepinephrine was additionally administered to achieve a mean arterial pressure between 65 and 75 mmHg, if necessary. Data from right heart catheterization, a thermodye dilution catheter, gastric tonometry and organ function were obtained at baseline and after 12, 24, 36 and 48 hours.

Results

No differences were found in terms of cardiac index, mixed-venous oxygen saturation, gastric mucosal-to-arterial carbon dioxide partial pressure and the plasma disappearance rate of indocyanine green. Compared with vasopressin and norepinephrine, terlipressin infusion allowed a marked reduction in catecholamine requirements at 48 hours (Table 1) and was associated with significantly less rebound hypotension as compared with vasopressin. Only one-half of the patients receiving terlipressin or vasopressin needed renal

Table 1 Norepinephrine requirements

Conclusion

Continuous low-dose terlipressin infusion (1.3 μg/kg/hour) represents an efficacious first-line treatment of septic shock patients. The hypothesis that terlipressin may be superior to vasopressin in septic shock needs to be confirmed in large-scale clinical trials.