Sepsis: Vasopressin

Pharmacology

Vasopressin (also, anti-diuretic hormone (ADH) or arginine vasopressin (AVP)) has been shown to be a very effective vasopressor, especially in circumstances where patients are vasopressin depleted and have become reliant on catecholamines for blood pressure regulation. Concerns for the use vasopressin tend to center on how it compares to other vasopressors, especially norepinephrine, and risks of digital and mesenteric ischemia.

Septic shock:

Vasoplegic shock:

Hemorrhagic & Hypovolemic shock:

Concerns for the use of vasopressin is usually due to its association with digital and mesenteric ischemia. These studies are often limited by lack of randomization and use of concurrent norepinephrine, among other inotropes and vasopressors. In Van Haren et al., 13 patients with septic shock were prospectively given vasopressin after fluid bolus, dobutamine, and norepinephrine to maintain MAPs > 50mmHg. These patients were not randomized. Gastric tonometry was used to determine gut perfusion which was found to be decreased in the study population, but again this study was not randomized and there was no control group (9). Dunser et al. retrospectively analyzed the incidence and risk factors for skin lesions in 63 critically ill patients receiving arginine vasopressin with catecholamine-resistant vasodilatory shock. Catecholamine resistance was defined failing effect of increasing norepinephrine 0.2ug/kg/min over 2 hours for maintenance of MAPs >60mmHg. Vasopressin doses were given 4-6 units/hour. 30% of patients developed skin lesions. But again, this was a retrospective study without randomization, and there was no control or matched group making generalization of the effects of vasopressin very difficult (10).

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2012

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