Effects of terlipressin on systemic and regional haemodynamics in catecholamine-treated hyperkinetic septic shock
- First Online:
- 246 Downloads
To determine the effects of an intravenous bolus dose of a vasopressin analogue, terlipressin (1 mg), on systemic haemodynamic parameters and gastric mucosal perfusion (GMP) in patients with catecholamine-treated septic shock using a gastric tonometry and laser-Doppler flowmetry technique.
Prospective open label study.
Two multidisciplinary intensive care units.
Fifteen patients with norepinephrine-treated septic shock.
Every patient with mean arterial pressure between 50 and 55 mmHg treated with high dose norepinephrine received an intravenous bolus dose of terlipressin as last resort therapy. A laser-Doppler probe and tonometer were introduced into the gastric lumen.
Measurements and main results
Terlipressin produced a decrease in cardiac output (p<0.05), a progressive increase in mean arterial pressure (p<0.05) and in GMP, detected by laser-Doppler flowmetry (p<0.05) over 30 min and sustained for at least 24 h. The ratio of GMP to systemic oxygen delivery increased after terlipressin bolus dose (p<0.05). The gradient between gastric mucosal and arterial PCO2 tended to be lower after terlipressin, and the difference was statistically significant (p<0.05) after 8 h. Terlipressin administration significantly increased (p<0.05) urine output compared to baseline and higher values were found at each set of measurement. The terlipressin-induced increase in urine output was associated with a significantly increased creatinine clearance (p<0.05). Reduction of the high-dose norepinephrine was observed in all patients (p<0.05).
Our findings showed that, in patients with norepinephrine-treated septic shock, terlipressin increased GMP, urine output and creatinine clearance by an increase in mean arterial pressure.
KeywordsGastric mucosal perfusion Septic shock Terlipressin Norepinephrine Laser-Doppler, tonometry
- 4.Schaller MD, Waeber B, Nusseberger Brunner HR (1985) Angiotensin I, vasopressin and sympathetic activity in conscious rats with endotoxemia. Am J Physiol 18:H1086-H1092Google Scholar
- 8.Egan JW, Jugus M, Kinter LB, Lee K, Smith EF (1989) Effect of a selective vasopressin receptor antagonist on the sequelae of endotoxemia in the conscious rat. Circ Res 29:155–166Google Scholar
- 12.Bernadich C, Bandi JC, Bosch J (1988) Effects of F-180, a new selective vasoconstrictor peptide compared with terlipressin and vasopressin on systemic and splanchnic haemodynamics in rat model of portal hypertension. Hepatology 27:351–356Google Scholar
- 13.Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655PubMedGoogle Scholar
- 17.Nicholson CD, Schmitt RA, Wilke R (1985) The effect of acute and chronic femoral artery ligation on the blood flow through the gastrocnemius muscle of the rat examined using laser-Doppler flowmetry and Xenon133 clearance. Int J Microcirc Clin Exp 4:151–171Google Scholar
- 18.Oberg A (1990) Laser-Doppler flowmetry. Biomedical Engineering 18:125–163Google Scholar
- 26.Iwao T, Toyonaga A, Oho K, Shigemori H, Sakai T, Tayama C, Masumoto H, Sato M, Tanikawa K (1996) Vasopressin plus oxygen vs vasopressin alone in cirrhotic patients with portal-hypertensive gastropathy: effects on gastric mucosal haemodynamics and oxygenation. J Gastroenterol Hepatol 11:216–222PubMedGoogle Scholar
- 32.Klinzing S, Schiergens V, Reinhart K (2002) Could vasopressin be an alternative for vasopressor therapy in sepsis? (abstract) Eur J Anaesthesiol 19:169–170Google Scholar
- 37.Patel BM, Chittok DR, Russel JA, Walley KR (2002) Beneficial effects of short-term vasopressin infusion during severe septic shock. Anaesthesiology 96:576–582Google Scholar