Assess the effects of vasopressin on hemodynamics of patients with Cardiogenic Shock (CS).
Retrospective chart review of 8 patients with CS defined as mean arterial pressure (MAP) < 60 mm Hg, decreased organ perfusion, cardiac index (CI) <2.5 L/min/m2 and pulmonary capillary occlusion pressure >15 mm Hg, who had a pulmonary artery catheter and received a continuous infusion of vasopressin.
The CI, after an infusion of vasopressin at a dose of 0.02 to 0.5 U/min, increased from a baseline of 1.8 to 2.3 L/min/m2 at 12 (+ 4) hours. The MAP increased from 53.3 to 62.75 mm Hg and the urine output from 21.8 to 39.9 ml/hour at 12 (+ 4) hours. Six out of 8 patients had an increased CI within the first 12 hours. Two had a drop in CI within the first 12 hours and one had a drop in CI at 24 hours. Of the 3 patients that had worsening in CI, one had a drop from 2.5 to 1.4 L/min/m2 at 12 hours on a dose of 0.08 U/min. Another had a drop from 2 to 1 L/min/m2 when the dose was increased from 0.1 to 0.2 U/min. A third, who initially had an increase in CI from 2.4 to 2.9 L/min/m2 on 0.1 U/min, had a subsequent drop to 1.3 L/min/m2 at 48 hours when the dose was increased from 0.1 to 0.5 U/min.
The use of vasopressin in CS caused, in this case series, an average increase in CI of 27.8 % and an average increase in urine output of 45.7% within the first 12 hours compared to baseline. CI decreased only when higher doses of vasopressin were used (in the range of 0.08 to 0.5 U/min).
The use of vasopressin in CS should be avoided at higher doses (> 0.08 U/min). The use of “physiologic” doses may deserve furtherinvestigation.
Walter Migotto, None.