(Circulation. 1999;100:226-229.)
© 1999 American Heart Association, Inc.
Brief Rapid Communications |
Reversal by Vasopressin of Intractable Hypotension in the Late Phase of Hemorrhagic Shock
From the Departments of Medicine, Surgery, and Anesthesiology, Columbia University College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032.
Correspondence to Donald W. Landry, MD, PhD, Director, Division of Clinical Pharmacology and Experimental Therapeutics, Columbia University, P&S Building, 10th Floor, Room 445, 630 W 168th St, New York, NY 10032.
Background—Hypovolemic shock of marked severity and duration may progress to cardiovascular collapse unresponsive to volume replacement and drug intervention. On the basis of clinical observations, we investigated the action of vasopressin in an animal model of this condition.
Methods and Results—In 7 dogs, prolonged hemorrhagic shock (mean
arterial pressure [MAP] of 
40 mm Hg) was induced
by exsanguination into a reservoir. After 30 minutes, progressive
reinfusion was needed to maintain MAP at 40 mm Hg, and by 1
hour, despite complete restoration of blood volume, the administration
of norepinephrine 3 µg · kg-1
· min-1 was required to maintain this pressure. At this
moment, administration of vasopressin 1 to 4 mU ·
kg-1 · min-1 increased MAP from 39±6
to 128±9 mm Hg (P<0.001), primarily because of
peripheral vasoconstriction. In 3 dogs subjected to similar
prolonged hemorrhagic shock, angiotensin II 180 ng ·
kg-1 · min-1 had only a marginal
effect on MAP (45±12 to 49±15 mm Hg). Plasma vasopressin was
markedly elevated during acute hemorrhage but fell from 319±66
to 29±9 pg/mL before administration of vasopressin
(P<0.01).
Conclusions—Vasopressin is a uniquely effective pressor in the irreversible phase of hemorrhagic shock unresponsive to volume replacement and catecholamine vasopressors. Vasopressin deficiency may contribute to the pathogenesis of this condition.
Key Words: vasopressin • shock • hemorrhage
This article has been cited by other articles:
 |
|
 |
|
  S. Milutinovic, D. Murphy, and N. Japundzic-Zigon The role of central vasopressin receptors in the modulation of autonomic cardiovascular controls: a spectral analysis study Am J Physiol Regulatory Integrative Comp Physiol, December 1, 2006; 291(6): R1579 - R1591. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Meybohm, E. Cavus, B. Bein, M. Steinfath, P.-A. Brand, J. Scholz, and V. Dorges Cerebral Metabolism Assessed with Microdialysis in Uncontrolled Hemorrhagic Shock After Penetrating Liver Trauma Anesth. Analg., October 1, 2006; 103(4): 948 - 954. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. V. Roth The use of vasopressin bolus to treat refractory hypotension secondary to reperfusion during orthotopic liver transplantation. Anesth. Analg., July 1, 2006; 103(1): 261 - 261. [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Atkins, B. W. Day, M. T. Handrigan, Z. Zhang, M. B. Pamnani, and N. V. Gorbunov Brisk production of nitric oxide and associated formation of S-nitrosothiols in early hemorrhage J Appl Physiol, April 1, 2006; 100(4): 1267 - 1277. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. I. Rudis and K. L. Rowland Current Concepts in Severe Sepsis and Septic Shock Journal of Pharmacy Practice, October 1, 2005; 18(5): 351 - 362. [Abstract] [PDF]
|
|
|
|
|
|
K. H. Stadlbauer, V. Wenzel, A. C. Krismer, W. G. Voelckel, and K. H. Lindner Vasopressin During Uncontrolled Hemorrhagic Shock: Less Bleeding Below the Diaphragm, More Perfusion Above Anesth. Analg., September 1, 2005; 101(3): 830 - 832. [Full Text] [PDF]
|
|
|
|
 |
|
 R. W. Schrier and W. Wang Acute Renal Failure and Sepsis N. Engl. J. Med., July 8, 2004; 351(2): 159 - 169. [Full Text] [PDF]
|
|
|
|
|
|
C. Raedler, W. G. Voelckel, V. Wenzel, A. C. Krismer, C. A. Schmittinger, H. Herff, V. D. Mayr, K. H. Stadlbauer, K. H. Lindner, and A. Konigsrainer Treatment of Uncontrolled Hemorrhagic Shock After Liver Trauma: Fatal Effects of Fluid Resuscitation Versus Improved Outcome After Vasopressin Anesth. Analg., June 1, 2004; 98(6): 1759 - 1766. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Gong, W. Wang, T.-H. Kwon, T. Jonassen, J. Frokiaer, and S. Nielsen Reduced renal expression of AQP2, p-AQP2 and AQP3 in haemorrhagic shock-induced acute renal failure Nephrol. Dial. Transplant., December 1, 2003; 18(12): 2551 - 2559. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-C. Yeh, C.-T. Wu, C.-H. Lu, C.-P. Yang, and C.-S. Wong Early Use of Small-Dose Vasopressin for Unstable Hemodynamics in an Acute Brain Injury Patient Refractory to Catecholamine Treatment: A Case Report Anesth. Analg., August 1, 2003; 97(2): 577 - 579. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. L.S. Morales, M. J. Garrido, J. D. Madigan, D. N. Helman, J. Faber, M. R. Williams, D. W. Landry, and M. C. Oz A double-blind randomized trial: prophylactic vasopressin reduces hypotension after cardiopulmonary bypass Ann. Thorac. Surg., March 1, 2003; 75(3): 926 - 930. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Soares Barreto-Filho, F. M. Consolim-Colombo, H. Ferreira Lopes, C. R. Martins Sobrinho, G. M. Guerra-Riccio, and E. M. Krieger Dysregulation of Peripheral and Central Chemoreflex Responses in Chagas' Heart Disease Patients Without Heart Failure Circulation, October 9, 2001; 104(15): 1792 - 1798. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. L. Holmes, B. M. Patel, J. A. Russell, and K. R. Walley Physiology of Vasopressin Relevant to Management of Septic Shock Chest, September 1, 2001; 120(3): 989 - 1002. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Landry and J. A. Oliver The Pathogenesis of Vasodilatory Shock N. Engl. J. Med., August 23, 2001; 345(8): 588 - 595. [Full Text] [PDF]
|
|
|
|
|
|
M. W. Dunser, A. J. Mayr, H. Ulmer, N. Ritsch, H. Knotzer, W. Pajk, G. Luckner, N. J. Mutz, and W. R. Hasibeder The Effects of Vasopressin on Systemic Hemodynamics in Catecholamine-Resistant Septic and Postcardiotomy Shock: A Retrospective Analysis Anesth. Analg., July 1, 2001; 93(1): 7 - 13. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. G. Voelckel, K. G. Lurie, K. H. Lindner, T. Zielinski, S. McKnite, A. C. Krismer, and V. Wenzel Vasopressin Improves Survival After Cardiac Arrest in Hypovolemic Shock Anesth. Analg., September 1, 2000; 91(3): 627 - 634. [Abstract] [Full Text] [PDF]
|
|