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

Authors

  • Ana Paula Metran Nascente Universidade Federal de São Paulo; Dor e Terapia Intensiva; Departamento de Anestesiologia
  • Flávio Geraldo Rezende Freitas Universidade Federal de São Paulo; Dor e Terapia Intensiva; Departamento de Anestesiologia
  • Jan Bakker University of New York; Department of Medicine. College of Physicians & Surgeons of Columbia; Division of Pulmonary, Allergy and Critical Care
  • Antônio Tonete Bafi Universidade Federal de São Paulo; Dor e Terapia Intensiva; Departamento de Anestesiologia
  • Renata Teixeira Ladeira Universidade Federal de São Paulo; Dor e Terapia Intensiva; Departamento de Anestesiologia
  • Luciano Cesar Pontes Azevedo Universidade Federal de São Paulo; Dor e Terapia Intensiva; Departamento de Anestesiologia
  • Alexandre Lima Erasmus University Rotterdam; Department of Intensive Care Adults
  • Flavia Ribeiro Machado Universidade Federal de São Paulo; Dor e Terapia Intensiva; Departamento de Anestesiologia

DOI:

https://doi.org/10.6061/clinics/2017(12)06

Keywords:

Septic Shock, Vasopressin, Microcirculation, Vasopressors, Hemodynamic

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.

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Published

2017-12-01

Issue

Section

Clinical Sciences

How to Cite

Nascente, A. P. M., Freitas, F. G. R., Bakker, J., Bafi, A. T., Ladeira, R. T., Azevedo, L. C. P., Lima, A., & Machado, F. R. (2017). Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline. Clinics, 72(12), 750-757. https://doi.org/10.6061/clinics/2017(12)06