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Intravenous Arginine Vasopressin Infusion in Refractory Vasodilatory Shock: A Clinical Study

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Abstract

Objective

To assess the efficacy of arginine vasopressin (AVP) as a rescue therapy in children with catecholamine refractory vasodilatory shock and its effect on various hemodynamic, clinical, and laboratory variables.

Methods

This prospective hospital based study was conducted from January 2008 through July 2008 at a tertiary pediatric cardiac critical care unit. Twelve post cardiac surgery patients with advanced vasodilatory shock requiring intravenous vasopressin infusion longer than 60 min were included and continuous vasopressin infusion was given. The primary outcome measures were restoration of Mean arterial blood pressure (MAP) after starting AVP infusion and decrease in other concurrent catecholamines requirement. The secondary outcome measures were survival to hospital discharge, adverse effects, and laboratory variables.

Results

Vasopressin was infused in the dose range of 0.0005 to 0.003units/kg/min for a mean duration of 55.6 h. MAP improved from 41.08 ± 6.15 mmHg at baseline to 48.92 ± 10.05 mmHg after 1 h (P < 0.05), to 57.01 ± 8.30 mmHg after 4 h of AVP infusion (P < 0.001), and to 62.33 ± 8.55 mmHg after 12 h (P < 0.001), which further increased to 71.75 ± 9.55 mmHg after 24 h (P < 0.001). Inotrope score and requirement of other concurrent inotropes declined significantly in all patients after starting AVP infusion (P < 0.001). Lactate levels also declined significantly (P < 0.0001). No significant adverse effect due to end organ ischemia was observed. Only one patient expired while on vasopressin infusion due to refractory hypotension.

Conclusions

Concurrent addition of vasopressin at an appropriate stage help improving MAP significantly with decreased dependence on high dose catecholamines without any significant adverse effects.

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References

  1. Landry DW, Oliver JA. The pathogenesis of vasodilatory shock. N Engl J Med. 2001;345:588–95.

    Article  PubMed  CAS  Google Scholar 

  2. Prielipp RC, Butterworth J. Cardiovascular failure and pharmacologic support of the peripheral vasculature after cardiac surgery. New Horiz. 1999;7:472–88.

    CAS  Google Scholar 

  3. The American Heart Association in Collaboration with the International Liaison Committee on Resuscitation (ILCOR). Part 6: Advanced cardiovascular life support. Section 6: Pharmacology II: agents to optimize cardiac output and blood pressure. Resuscitation. 2000;46:55–62.

    Google Scholar 

  4. Farand P, Hamel M, Lauzier F, Plante GE, Lesur O. Organ perfusion/permeability-related effects of norepinephrine and vasopressin in sepsis. Can J Anesth. 2006;53:934–46.

    Article  PubMed  Google Scholar 

  5. Landry DW, Levin HR, Gallant EM, et al. Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation. 1997;95:1122–5.

    PubMed  CAS  Google Scholar 

  6. Landry DW. Vasopressin deficiency and hypersensitivity in vasodilatory shock: discovery of a new clinical syndrome. P&S Med Rev. 1996;3:3–4.

    Google Scholar 

  7. Landry DW, Levin HR, Gallant EM, et al. Vasopressin pressor hypersensitivity in vasodilatory septic shock. Crit Care Med. 1997;25:1279–82.

    Article  PubMed  CAS  Google Scholar 

  8. Argenziano M, Chen JM, Choudhri AF, et al. Management of vasodilatory shock after cardiac surgery: identification of predisposing factors and use of a novel pressor agent. J Thorac Cardiovasc Surg. 1998;116:973–80.

    Article  PubMed  CAS  Google Scholar 

  9. Luckner G, Dünser MW, Jochberger S, et al. Arginine vasopressin in 316 patients with advanced vasodilatory shock. Crit Care Med. 2005;33:2659–66.

    Article  PubMed  CAS  Google Scholar 

  10. Dunser MW, Mayr AJ, Ulmer H, et al. Arginine vasopressin in advanced vasodilatory shock: a prospective, randomized, controlled study. Circulation. 2003;107:2313–9.

    Article  PubMed  Google Scholar 

  11. Efrati O, Modan-Moses D, Vaedi A, Matok I, Bazilay Z, Paret G. Intravenous arginine vasopressin in critically ill children: is it beneficial? Shock. 2004;22:213–7.

    Article  PubMed  CAS  Google Scholar 

  12. Masutani S, Senzaki H, Ishido H, et al. Vasopressin in the treatment of vasodilatory shock in children. Pediatr Int. 2005;47:132–6.

    Article  PubMed  CAS  Google Scholar 

  13. Rosenzweig EB, Starc TJ, Chen JM, et al. Intravenous arginine vasopressin infusions in children with vasodilatory shock after cardiac surgery. Circulation. 1999;100:II182–6.

    PubMed  CAS  Google Scholar 

  14. Holmes CL, Walley KR, Chittock DR, Lehman T, Russell JA. The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series. Intensive Care Med. 2001;27:1416–21.

    Article  PubMed  CAS  Google Scholar 

  15. Meyer S, Gottschling S, Baghai A, Wurm D, Gortner L. Arginine- vasopressin in catecholamine-refractory septic versus non-septic shock in extremely low birth weight infants with acute renal injury. Criti Care. 2006;10:R71.

    Article  Google Scholar 

  16. Rodríguez-Núñnez A, López-Herce J, Gíl-Antón J, Hernández A, Rey C, RETSPED Working Group of the Spanish Society of Pediatric Intensive Care. Rescue treatment with terlipressin in children with refractory septic shock: a clinical study. Crit Care. 2006;10:R20.

    Article  Google Scholar 

  17. Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definition for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6:2–8.

    Article  PubMed  Google Scholar 

  18. Wernovsky G, Wypij D, Jonas RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants: a comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation. 1995;92:2226–35.

    PubMed  CAS  Google Scholar 

  19. Kulik TJ, Moler FW, Palmisano JM, et al. Outcome-associated factors in pediatric patients treated with extracorporeal membrane oxygenator after cardiac surgery. Circulation. 1996;94:II63–8.

    PubMed  CAS  Google Scholar 

  20. Carrel T, Englberger L, Mohacsi P, Neidhart P, Schmidli J. Low systemic vascular resistance after cardiopulmonary bypass: incidence, etiology, and clinical importance. J Card Surg. 2000;15:347–53.

    Article  PubMed  CAS  Google Scholar 

  21. Wakatsuki T, Nakaya Y, Inoue I. Vasopressin modulates potassium channel activities of cultured smooth muscle cells from porcine coronary artery. Am J Physiol. 1992;263:H491–6.

    PubMed  CAS  Google Scholar 

  22. Lechner E, Hofer A, Mair R, et al. Arginine vasopressin in neonates with vasodilatory shock after cardio pulmonary bypass. Eur J Pediatr. 2007;166:1221–7.

    Article  PubMed  CAS  Google Scholar 

  23. Meyer S, Gortner L, McGuire W, Baghai A, Gottschling S. Vasopressin in catecholamine-refractory shock in children. Anaesthesia. 2008;63:228–34.

    Article  PubMed  CAS  Google Scholar 

  24. Yildizdas D, Yapicioglu H, Celik U, Sertdemir Y, Alhan E. Terlipressin as a rescue therapy for catecholamine resistant shock in children. Intensive Care Med. 2008;34:511–7.

    Article  PubMed  CAS  Google Scholar 

  25. Russell JA, Walley KR, Gordon AC, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008;358:877–87.

    Article  PubMed  CAS  Google Scholar 

  26. Choong K, Bohn D, Fraser DD, et al. Vasopressin in pediatric vasodilatory shock: a multicenter randomized controlled trial. Am J Respir Crit Care Med. 2009;180:632–9.

    Article  PubMed  CAS  Google Scholar 

  27. Jerath N, Frndova H, McCrindle BW, Gurofsky R, Humpl T. Clinical Impact of Vasopressin infusion on heamodynamics, liver and renal functions in pediatric patients. Intensive Care Med. 2008;34:1247–80.

    Google Scholar 

  28. Dünser MW, Mayr AJ, Ulmer H, et al. The effects of vasopressin on systemic hemodynamics in catecholamine-resistant septic and postcardiotomy shock: a retrospective analysis. Anesth Analg. 2001;93:7–11.

    Article  PubMed  Google Scholar 

  29. Dünser MW, Fries DR, Schobers-berger W, et al. Does arginine vasopressin influence the coagulation system in advanced vasodilatory shock with multiorgan dysfunction syndrome? Anesth Analg. 2004;99:201–6.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Chirayu Medical College and Hospital, Bhopal, MP, India

    Amit Agrawal

  2. Department of Critical Care Medicine, Escorts Heart Institute and Research Centre, New Delhi, India

    Vishal K. Singh

  3. Department of Critical Care Medicine, Fortis and Escorts Heart Institute and Research Centre, New Delhi, India

    Amit Varma

  4. Department of Pediatric Cardiac Surgery, Escorts Heart Institute and Research Centre, New Delhi, India

    Rajesh Sharma

  5. H. No. 28, Ravidas Nagar, Near Nizamuddin Colony, Indrapuri, Bhopal, MP, 462023, India

    Amit Agrawal

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  1. Amit Agrawal
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Correspondence to Amit Agrawal.

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Agrawal, A., Singh, V.K., Varma, A. et al. Intravenous Arginine Vasopressin Infusion in Refractory Vasodilatory Shock: A Clinical Study. Indian J Pediatr 79, 488–493 (2012). https://doi.org/10.1007/s12098-011-0557-z

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  • DOI: https://doi.org/10.1007/s12098-011-0557-z

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