Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , , , , |
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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Clinics |
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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 |
_version_ |
1800222763634393088 |