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

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Abstract

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 >0.6 μg/kg/min were randomized to receive a supplementary AVP infusion either at 0.033 IU/min (n = 25) or 0.067 IU/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 48 h 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 0.067 IU/min required less norepinephrine (P = 0.006) than those infused with AVP at 0.033 IU/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 0.067 IU/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 (0.033 IU/min, 52%; 0.067 IU/min, 52%; P = 1).

Conclusions

A supplementary AVP infusion of 0.067 IU/min restores cardiovascular function in patients with advanced vasodilatory shock more effectively than AVP at 0.033 IU/min.

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Conflict of interest statement

No author has a conflict of interest in regards to the drugs or methods discussed in this manuscript.

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Authors and Affiliations

  1. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria

    Christian Torgersen, Volker Wenzel, Stefan Jochberger, Viktoria Mayr, Christian A. Schmittinger, Ingo Lorenz, Stefan Schmid & Günter Luckner

  2. Department of Intensive Care Medicine, Inselspital, Freiburgerstrasse, 3010, Bern, Switzerland

    Martin W. Dünser

  3. Department of Anesthesiology and Intensive Care, University Hospital of Muenster, Muenster, Germany

    Martin Westphal

  4. Department of Internal Medicine, Community Hospital Hall in Tirol, Hall in Tirol, Austria

    Wilhelm Grander

Authors
  1. Christian Torgersen
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  2. Martin W. Dünser
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  3. Volker Wenzel
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  4. Stefan Jochberger
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  5. Viktoria Mayr
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  6. Christian A. Schmittinger
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  7. Ingo Lorenz
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  8. Stefan Schmid
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  9. Martin Westphal
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  10. Wilhelm Grander
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  11. Günter Luckner
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Corresponding author

Correspondence to Martin W. Dünser.

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Torgersen, C., Dünser, M.W., Wenzel, V. et al. Comparing two different arginine vasopressin doses in advanced vasodilatory shock: a randomized, controlled, open-label trial. Intensive Care Med 36, 57–65 (2010). https://doi.org/10.1007/s00134-009-1630-1

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  • DOI: https://doi.org/10.1007/s00134-009-1630-1

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