CLINICS

Clinics (Sao Paulo). 2017 December; 72(12): 750-757.
doi:10.6061/clinics/2017(12)06

Copyright © 2017 CLINICS

Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline

Ana Paula Metran Nascente I , Flávio Geraldo Rezende Freitas I , Jan Bakker II III , Antônio Tonete Bafi I , Renata Teixeira Ladeira I , Luciano Cesar Pontes Azevedo I , Alexandre Lima II , Flavia Ribeiro Machado I *

Departamento de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR

Department of Intensive Care Adults, Erasmus MC - University Hospital Rotterdam, the Netherlands

Division of Pulmonary, Allergy and Critical Care, Department of Medicine. College of Physicians & Surgeons of Columbia, University of New York, USA

*Corresponding author. E-mail: frmachado@unifesp.br

received May 31, 2017; revised July 17, 2017; accepted October 11, 2017.

Abstract

OBJECTIVES:

To assess the impact of vasopressin on the microcirculation and to develop a predictive model to estimate the probability of microcirculatory recruitment in patients with septic shock.

METHODS:

This prospective interventional study included patients with septic shock receiving noradrenaline for less than 48 hours. We infused vasopressin at 0.04 U/min for one hour. Hemodynamic measurements, including sidestream dark-field imaging, were obtained immediately before vasopressin infusion, 1 hour after vasopressin infusion and 1 hour after vasopressin withdrawal. We defined patients with more than a 10% increase in total vascular density and perfused vascular density as responders. ClinicalTrials.gov: NCT02053675.

RESULTS:

Eighteen patients were included, and nine (50%) showed improved microcirculation after infusion of vasopressin. The noradrenaline dose was significantly reduced after vasopressin (p=0.001) and was higher both at baseline and during vasopressin infusion in the responders than in the non-responders. The strongest predictor for a favorable microcirculatory response was the dose of noradrenaline at baseline (OR=4.5; 95% CI: 1.2-17.0; p=0.027). For patients using a noradrenaline dose higher than 0.38 mcg/kg/min, the probability that microcirculatory perfusion would be improved with vasopressin was 53% (sensitivity 78%, specificity 77%).

CONCLUSIONS:

In patients with septic shock for no longer than 48 h, administration of vasopressin is likely to result in an improvement in microcirculation when the baseline noradrenaline dose is higher than 0.38 mcg/kg/min.

Keywords: Septic Shock, Vasopressin, Microcirculation, Vasopressors, Hemodynamic


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