Vasopressin or norepinephrine in early hyperdynamic septic shock: a randomized clinical trial.

Author(s): Lauzier F, Levy B, Lamarre P, Lesur O

Affiliation(s): Soins Intensifs Medicaux et Chirurgicaux, Centre de Recherche Clinique, Centre Hospitalier Universitaire de Sherbrooke, 12eme Avenue Nord, 3001, J1H[Symbol: see text]5N4, Sherbrooke, QC, Canada, Olivier.Lesur@USherbrooke.ca.

Publication date & source: 2006-11, Intensive Care Med., 32(11):1782-9. Epub 2006 Sep 22.

OBJECTIVE: To compare the effects of arginine-vasopressin (AVP) and norepinephrine (NE) on hemodynamic variables, organ dysfunction, and adverse events in early hyperdynamic septic shock. DESIGN AND SETTING: Randomized, controlled, open-label trial. PATIENTS AND PARTICIPANTS: Twenty-three patients with early (12[Symbol: see text]h) hyperdynamic septic shock in two teaching hospitals. INTERVENTIONS: AVP (0.04-0.20 U[Symbol: see text]min(-1), n[Symbol: see text]=[Symbol: see text]13) as a single agent or NE (0.1-2.8[Symbol: see text]mug[Symbol: see text]kg(-1)[Symbol: see text]min(-1), n[Symbol: see text]=[Symbol: see text]10) infusion for 48[Symbol: see text]h to achieve mean arterial pressure at or above 70[Symbol: see text]mmHg. MEASUREMENTS AND RESULTS: Hemodynamic parameters and Sequential Organ Failure Assessment (SOFA) score were measured. AVP and NE equally increased mean arterial pressure over 48[Symbol: see text]h, but NE was required in 36% of AVP patients at 48[Symbol: see text]h. Compared to baseline, AVP increased systemic vascular resistance, decreased exposure to NE, decreased cardiac output by decreasing heart rate, increased creatinine clearance, and improved SOFA score. The PrCO(2) - PaCO(2) difference remained stable throughout the study. One AVP patient developed acute coronary syndrome with dose-dependent ECG changes. Three patients in both groups died during their ICU stay. CONCLUSION: In early hyperdynamic septic shock, the administration of high-dose AVP as a single agent fails to increase mean arterial pressure in the first hour but maintains it above 70[Symbol: see text]mmHg in two-thirds of patients at 48[Symbol: see text]h. AVP decreases NE exposure, has no effect on the PrCO(2) - PaCO(2 )difference, and improves renal function and SOFA score.