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

Detalhes bibliográficos
Autor(a) principal: Nascente, Ana Paula Metran
Data de Publicação: 2017
Outros Autores: Freitas, Flávio Geraldo Rezende, Bakker, Jan, Bafi, Antônio Tonete, Ladeira, Renata Teixeira, Azevedo, Luciano Cesar Pontes, Lima, Alexandre, Machado, Flavia Ribeiro
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Clinics
Texto Completo: https://www.revistas.usp.br/clinics/article/view/142553
Resumo: 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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spelling Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenalineSeptic ShockVasopressinMicrocirculationVasopressorsHemodynamicOBJECTIVES: 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.Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo2017-12-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.revistas.usp.br/clinics/article/view/14255310.6061/clinics/2017(12)06Clinics; Vol. 72 No. 12 (2017); 750-757Clinics; v. 72 n. 12 (2017); 750-757Clinics; Vol. 72 Núm. 12 (2017); 750-7571980-53221807-5932reponame:Clinicsinstname:Universidade de São Paulo (USP)instacron:USPenghttps://www.revistas.usp.br/clinics/article/view/142553/137586Copyright (c) 2018 Clinicsinfo:eu-repo/semantics/openAccessNascente, Ana Paula MetranFreitas, Flávio Geraldo RezendeBakker, JanBafi, Antônio ToneteLadeira, Renata TeixeiraAzevedo, Luciano Cesar PontesLima, AlexandreMachado, Flavia Ribeiro2018-01-23T10:06:01Zoai:revistas.usp.br:article/142553Revistahttps://www.revistas.usp.br/clinicsPUBhttps://www.revistas.usp.br/clinics/oai||clinics@hc.fm.usp.br1980-53221807-5932opendoar:2018-01-23T10:06:01Clinics - Universidade de São Paulo (USP)false
dc.title.none.fl_str_mv Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline
title Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline
spellingShingle Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline
Nascente, Ana Paula Metran
Septic Shock
Vasopressin
Microcirculation
Vasopressors
Hemodynamic
title_short Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline
title_full Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline
title_fullStr Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline
title_full_unstemmed Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline
title_sort Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline
author Nascente, Ana Paula Metran
author_facet Nascente, Ana Paula Metran
Freitas, Flávio Geraldo Rezende
Bakker, Jan
Bafi, Antônio Tonete
Ladeira, Renata Teixeira
Azevedo, Luciano Cesar Pontes
Lima, Alexandre
Machado, Flavia Ribeiro
author_role author
author2 Freitas, Flávio Geraldo Rezende
Bakker, Jan
Bafi, Antônio Tonete
Ladeira, Renata Teixeira
Azevedo, Luciano Cesar Pontes
Lima, Alexandre
Machado, Flavia Ribeiro
author2_role author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Nascente, Ana Paula Metran
Freitas, Flávio Geraldo Rezende
Bakker, Jan
Bafi, Antônio Tonete
Ladeira, Renata Teixeira
Azevedo, Luciano Cesar Pontes
Lima, Alexandre
Machado, Flavia Ribeiro
dc.subject.por.fl_str_mv Septic Shock
Vasopressin
Microcirculation
Vasopressors
Hemodynamic
topic Septic Shock
Vasopressin
Microcirculation
Vasopressors
Hemodynamic
description 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.
publishDate 2017
dc.date.none.fl_str_mv 2017-12-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://www.revistas.usp.br/clinics/article/view/142553
10.6061/clinics/2017(12)06
url https://www.revistas.usp.br/clinics/article/view/142553
identifier_str_mv 10.6061/clinics/2017(12)06
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv https://www.revistas.usp.br/clinics/article/view/142553/137586
dc.rights.driver.fl_str_mv Copyright (c) 2018 Clinics
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2018 Clinics
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
publisher.none.fl_str_mv Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
dc.source.none.fl_str_mv Clinics; Vol. 72 No. 12 (2017); 750-757
Clinics; v. 72 n. 12 (2017); 750-757
Clinics; Vol. 72 Núm. 12 (2017); 750-757
1980-5322
1807-5932
reponame:Clinics
instname:Universidade de São Paulo (USP)
instacron:USP
instname_str Universidade de São Paulo (USP)
instacron_str USP
institution USP
reponame_str Clinics
collection Clinics
repository.name.fl_str_mv Clinics - Universidade de São Paulo (USP)
repository.mail.fl_str_mv ||clinics@hc.fm.usp.br
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