AI Article Synopsis
- - Vasopressin is an alternative treatment for severe septic shock, but loading doses aren’t typically used due to safety concerns; this study explores its potential benefits and safety through a planned loading approach.
- - In this study, 92 patients receiving noradrenaline for septic shock were monitored, with those showing a significant increase in mean arterial pressure (MAP) after a vasopressin loading dose classified as responders; results showed differences in hormonal levels and cardiac function between responders and non-responders.
- - The study found that responders had notable changes in the catecholamine index after six hours, indicating better overall response to vasopressin, with a high AUROC value suggesting effective prediction of treatment response, although
Article Abstract
Background: Vasopressin is a second-line vasoactive agent for refractory septic shock. Vasopressin loading is not generally performed because of the lack of evidence for its effects and safety. However, based on our previous findings, we hypothesized it can predict the responsibility to vasopressin infusion with safety, and prospectively examined it in the present study.
Methods: Vasopressin loading was performed via the intravenous administration of a bolus of 1 U, followed by its continuous infusion at 1U/h in patients with septic shock treated with ≥ 0.2 μg/kg/min noradrenaline. An arterial pressure wave analysis was conducted, and endocrinological tests were performed immediately prior to vasopressin loading. We classified patients into responders/non-responders based on mean arterial pressure (MAP) changes after vasopressin loading. Based on our previous findings, the lower tertile of MAP changes was selected as the cut-off. The change in the catecholamine index (CAI) after 6 h was assigned as the primary outcome. Digital ischemia, mesenteric ischemia, and myocardial ischemia during the admission period were prospectively and systematically recorded as adverse events.
Results: Ninety-two patients were registered during the study period and examined. Sixty-two patients with a MAP change > 22 mmHg were assigned as responders and the others as non-responders. Blood adrenocorticotropic hormone levels were significantly higher in non-responders. Stroke volume variations were higher in responders before loading, while stroke volume and dP/dt were higher in responders after loading. Median CAI changes were - 10 in responders and 0 in non-responders, which was significantly lower in the former (p < 0.0001). AUROC of MAP change with vasopressin loading to predict CAI change < 0 after continuous infusion was 0.843 with sensitivity of 0.92 and specificity of 0.77. Ischemia events were observed in 5 cases (5.4%).
Conclusions: Vasopressin loading may be safely introduced for septic shock. Vasopressin loading may be used to predict responses to its continuous infusion and select appropriate strategies to increase blood pressure.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10362561 | PMC |
| http://dx.doi.org/10.1186/s13054-023-04583-7 | DOI Listing |
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