Comparison of two dose regimens of arginine vasopressin in advanced vasodilatory shock.
Even though not an establish part of guidelines and literature is not plenty either, vasopressin has fastly become an integral pressor in most ICUs across USA. Usual acceptable dose is 0.04 units/min.
Very recently, a retrospective controlled study of 78 patients published, to evaluate the effects of two vasopressin dose regimens (0.033 vs. 0.067 IU/min) on treatment efficacy, hemodynamic response, prevalence of adverse events, and changes in laboratory variables.
78 patients with vasodilatory shock (mean norepinephrine dosage, 1.07 mcg//min were given supplementary infusion of vasopressin. 2 groups were
- 0.033 (n = 39) and
- 0.067 IU/min (n = 39)
Cardiocirculatory, laboratory, and clinical variables were evaluated and compared between groups before and at 0.5, 1, 4, 12, 24, 48, and 72 hrs after initiation of Vasopressin (AVP).
Treatment efficacy was assessed by the increase in mean arterial blood pressure and the extent of norepinephrine reduction during the first 24 hrs of vasopressin therapy.
Results:
- Although the relative increase in mean arterial pressure was comparable between groups (16.8 +/- 18.4 vs. 21.4 +/- 14.9 mm Hg), norepinephrine could be reduced significantly more often in patients receiving 0.067 IU/min.
- AVP at 0.067 IU/min resulted in a higher mean arterial pressure (p < .001), lower central venous pressure (p = .001), lower mean pulmonary arterial pressure (p = .04), and lower norepinephrine requirements (p < .001) during the 72-hr observation period.
- Increases in liver enzymes occurred more often in patients treated with 0.033 IU/min (71.8% vs. 28.2% - p < .001) !
- The prevalence of a decrease in cardiac index, decrease in platelet count, and increase in total bilirubin was not significantly different between groups.
- Base deficit were lower and arterial lactate concentrations higher in patients receiving 0.033 IU/min.
Conclusions: Vasopressin dosages of 0.067 IU/min seem to be more effective to reverse cardiovascular failure in vasodilatory shock requiring high norepinephrine dosages than 0.033 IU/min.
Reference: click to get abstract/article
Comparison of two dose regimens of arginine vasopressin in advanced vasodilatory shock. - Critical Care Medicine. 35(10):2280-2285, October 2007.
