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CARDIOVASCULAR ANESTHESIA

The Effects of Vasopressin on Systemic Hemodynamics in Catecholamine-Resistant Septic and Postcardiotomy Shock: A Retrospective Analysis

Martin W. Dünser, MD^*, Andreas J. Mayr, MD^*, Hanno Ulmer, PhD, Nicole Ritsch, MD^*, Hans Knotzer, MD^*, Werner Pajk, MD^*, Günther Luckner, MD^*, Norbert J. Mutz, MD^*, and Walter R. Hasibeder, MD^*

*Division of General and Surgical Intensive Care Medicine, Department of Anesthesia and Critical Care Medicine; and Department of Medical Biostatistics, The Leopold Franzens University of Innsbruck, Innsbruck, Austria

Address correspondence and reprint requests to Walter R. Hasibeder, MD, Division of General and Surgical Intensive Care Medicine, Department of Anesthesia and Critical Care Medicine, The Leopold Franzens University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Address e-mail to Walter.Hasibeder@ uibk.ac.at.

We retrospectively investigated the effects of continuous arginine vasopressin (AVP) infusion on systemic hemodynamics, acid/base status, and laboratory variables in patients (mean age [mean ± SD]= 66.3 ± 10.1 yr) with catecholamine-resistant septic (n = 35) or postcardiotomy shock (n = 25). Hemodynamic and acid/base data were obtained before; 30 min after; and 1, 4, 12, 24, 48, and 72 h after the start of AVP infusion. Laboratory examinations were recorded before and 24, 48, and 72 h after the start of AVP infusion. For statistical analysis, a mixed-effects model was used. The overall intensive care unit mortality was 66.7%. AVP administration caused a significant increase in mean arterial pressure (+29%) and systemic vascular resistance (+56%), accompanied by a significant decrease in heart rate (-24%) and mean pulmonary arterial pressure (-11%) without any change in stroke volume index. Norepinephrine requirements could be reduced by 72% within 72 h. During AVP infusion, a significant increase in liver enzymes and total bilirubin concentration and a significant decrease in platelet count occurred. Arginine vasopressin was effective in reversing systemic hypotension. However, adverse effects on gastrointestinal perfusion and coagulation cannot be excluded.

Implications: In this retrospective analysis, the influence of a continuous infusion of anendogenous hormone (arginine vasopressin) on systemic hemodynamics andlaboratory variables was assessed in patients with vasodilatory shockunresponsive to conventional therapy. Arginine vasopressin was effective inreversing systemic hypotension. However, adverse effects on gastrointestinalperfusion and coagulation cannot beexcluded.

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