To evaluate the impact of vasopressin on the hemodynamics of septic patients when used as a last line salvage therapy.
Retrospective chart review of patients that were on vasopressin infusion for septic shock. Data abstracted included patients’ demographics, medical history, clinical presentation, and hemodynamics. Blood pressure and requirements of vasoactive medications were recorded at baseline, one hour, four hours, twelve hours, twenty four hours and forty eight hours after starting vasopressin infusion, and were compared using paired t-test. Continuous variables are expressed as mean ± SEM.
19 patients were reviewed. The average age was 44 ± 6. 32% had cirrhosis as an underlying diseases. Source of septic shock was respiratory in 47 %. Vasopressin was initiated after a mean of 85 ± 31 hours of starting the first vasoactive medication and was continued for a mean of 108 ±37 hours. Average dose of norepinephrine and dopamine at baseline before starting vasopressin was 0.72 ± 0.11 mcg/kg/min and 7.83 ± 2 mcg/kg/min respectively. Mean arterial blood pressure improved during the first hour of vasopressin infusion (61± 2 to 69 ±3 p=0.01). This improvement was not sustained during subsequent points of the study. Vasopressin did not result in statistically significant bradycardia nor was successful in reducing the requirements of other vasoactive medications.CONCLUSIONS: The use of vasopressin as a salvage therapy for septic patients is associated with only transient improvement in hemodynamics during the first hour of infusion after failure of all other vasoactive medications. Vasopressin was not associated with significant bradycardia and did not succeed in reducing vasoactive medications requirements. The small numbers and retrospective design limit our results.
When used as a salvage therapy late in the course of septic shock, vasopressin is not an effective medication in reversing shock .The late initiation of infusion may explain the ineffectiveness. Early infusion of vasopressin may produce different data. Randomized studies are necessary in this area.
O. Dabbagh, None.