PURPOSE: Vasopressin (AVP) has become a popular, second-line treatment for septic shock. We compared current AVP use and outcome in septic shock to our early practice when AVP was first introduced for septic shock.
METHODS: Charts of surgical ICU patients receiving AVP for septic shock between July 2005 and June 2006 were retrospectively reviewed. Demographics, APACHE II, MOD score, hemodynamic, laboratory, vasoactive drug data, and sepsis therapy were compared to a similar 1999–2000 drug utilization review. Statistical analysis included general linear model repeated measures, independent and paired samples t-test, Chi-square test, Kaplan-Meyer, and Cox regression analysis (p<0.05 considered significant).
RESULTS: 31 SICU patients (21 males/10 females) in the current group and 20 patients (13 males/7 females) in the early group met study criteria. Age, weight, gender, SICU length of stay and AVP treatment duration were similar in the current vs. early group. APACHE II (23 ± 7 vs. 34 ± 9), MOD score (9 ± 4 vs. 13 ± 4), baseline AVP dose (0.04 ± 0.02 units/min vs. 0.09 ± 0.11 units/min), and SICU survival rate (45% vs. 15%) significantly changed (p<0.01). The mean arterial pressure significantly increased from baseline at all measured time points during both periods (p<0.05). Heart rate significantly diminished (108 ± 22 bpm vs. 99 ± 18 bpm) (p<0.01) after the first hour of AVP infusion in the current group. Other hemodynamic variables, additional vasoactive drug use, urine output, creatinine, lactate, and adverse events reported in literature (bilirubin, transaminase and serum sodium) were not significantly altered during AVP infusion. With multivariate analysis, APACHE II and MOD score were independent factors influencing survival.
CONCLUSION: AVP is currently being used at lower doses and in less severe septic shock. Current patients treated with AVP have a higher SICU survival rate than 5–7 years ago.
CLINICAL IMPLICATIONS: The lower AVP dose currently used is as hemodynamically reliable and safe in septic shock as the higher doses used when it was first introduced.
DISCLOSURE: Monica Lupei, None.