Published online before print May 5, 2003, doi: 10.1161/01.CIR.0000066692.71008.BB
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(Circulation. 2003;107:2313.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Arginine Vasopressin in Advanced Vasodilatory Shock
A Prospective, Randomized, Controlled Study
From the Division of General and Surgical Intensive Care Medicine, Department of Anaesthesia and Critical Care Medicine (M.W.D., A.J.M., H.K., G.S., W.P., B.F., W.R.H.), and Department of Medical Biostatistics (H.U.), The Leopold Franzens University of Innsbruck, Austria.
Correspondence to Walter R. Hasibeder, MD, Division of General and Surgical Intensive Care Medicine, Department of Anesthesia and Critical Care Medicine, The Leopold Franzens University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. E-mail Walter.Hasibeder{at}uibk.ac.at
Background— Vasodilatory shock is a potentially lethal complication of severe disease in critically ill patients. Currently, catecholamines are the most widely used vasopressor agents to support blood pressure, but loss of catecholamine pressor effects is a well-known clinical dilemma. Arginine vasopressin (AVP) has recently been shown to be a potent vasopressor agent to stabilize cardiocirculatory function even in patients with catecholamine-resistant vasodilatory shock.
Methods and Results— Forty-eight patients with catecholamine-resistant vasodilatory shock were prospectively randomized to receive a combined infusion of AVP and norepinephrine (NE) or NE infusion alone. In AVP patients, AVP was infused at a constant rate of 4 U/h. Hemodynamic, acid/base, single-organ, and tonometrically derived gastric variables were reported before the study and 1, 12, 24, and 48 hours after study entry. For statistical analysis, a mixed-effects model was used. AVP patients had significantly lower heart rate, NE requirements, and incidence of new-onset tachyarrhythmias than NE patients. Mean arterial pressure, cardiac index, stroke volume index, and left ventricular stroke work index were significantly higher in AVP patients. NE patients developed significantly more new-onset tachyarrhythmias than AVP patients (54.3% versus 8.3%). Gastrointestinal perfusion as assessed by gastric tonometry was better preserved in AVP-treated patients. Total bilirubin concentrations were significantly higher in AVP patients.
Conclusions— The combined infusion of AVP and NE proved to be superior to infusion of NE alone in the treatment of cardiocirculatory failure in catecholamine-resistant vasodilatory shock.
Key Words: vasopressin • norepinephrine • shock, vasodilatory • shock, postcardiotomy • shock, septic
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