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Comparing two different arginine vasopressin doses in advanced vasodilatory shock: a randomized, controlled, open-label trial

Torgersen, Christian ; Dünser, Martin ; Wenzel, Volker ; Jochberger, Stefan ; Mayr, Viktoria ; Schmittinger, Christian ; Lorenz, Ingo ; Schmid, Stefan ; Westphal, Martin ; Grander, Wilhelm ; Luckner, Günter

In: Intensive Care Medicine, 2010, vol. 36, no. 1, p. 57-65

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    Titre
    • Comparing two different arginine vasopressin doses in advanced vasodilatory shock: a randomized, controlled, open-label trial
    Auteur
    • Torgersen, Christian. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
    • Dünser, Martin. Department of Intensive Care Medicine, Inselspital, Freiburgerstrasse, 3010, Bern, Switzerland
    • Wenzel, Volker. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
    • Jochberger, Stefan. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
    • Mayr, Viktoria. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
    • Schmittinger, Christian. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
    • Lorenz, Ingo. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
    • Schmid, Stefan. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
    • Westphal, Martin. Department of Anesthesiology and Intensive Care, University Hospital of Muenster, Muenster, Germany
    • Grander, Wilhelm. Department of Internal Medicine, Community Hospital Hall in Tirol, Hall in Tirol, Austria
    • Luckner, Günter. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:313555
    Summary
    Purpose: To compare the effects of two arginine vasopressin (AVP) dose regimens on the hemodynamic response, catecholamine requirements, AVP plasma concentrations, organ function and adverse events in advanced vasodilatory shock. Methods: In this prospective, controlled, open-label trial, patients with vasodilatory shock due to sepsis, systemic inflammatory response syndrome or after cardiac surgery requiring norepinephrine >0.6μg/kg/min were randomized to receive a supplementary AVP infusion either at 0.033IU/min (n=25) or 0.067IU/min (n=25). The hemodynamic response, catecholamine doses, laboratory and organ function variables as well as adverse events (decrease in cardiac index or platelet count, increase in liver enzymes or bilirubin) were recorded before, 1, 12, 24 and 48h after randomization. A linear mixed effects model was used for statistical analysis in order to account for drop-outs during the observation period. Results: Heart rate and norepinephrine requirements decreased while MAP increased in both groups. Patients receiving AVP at 0.067IU/min required less norepinephrine (P=0.006) than those infused with AVP at 0.033IU/min. Arterial lactate and base deficit decreased while arterial pH increased in both groups. During the observation period, AVP plasma levels increased in both groups (both P<0.001), but were higher in the 0.067IU/min group (P<0.001) and in patients on concomitant hydrocortisone. The rate of adverse events and intensive care unit mortality was comparable between groups (0.033IU/min, 52%; 0.067IU/min, 52%; P=1). Conclusions: A supplementary AVP infusion of 0.067IU/min restores cardiovascular function in patients with advanced vasodilatory shock more effectively than AVP at 0.033IU/min