Arginine vasopressin and terlipressin increase mean arterial pressure and reduce catecholamine requirements in septic shock patients. Infusing either agent may reduce incidence of new-onset tachyarrhythmias and improve renal function. The recent Vasopressin and Septic Shock Trial did not demonstrate an overall survival benefit of arginine vasopressin infusion (0.03 U/min) compared with norepinephrine (15 microg/min). However, patients with less severe septic shock (ie, < 15 microg/min of norepinephrine) at arginine vasopressin initiation had a lower 28-day mortality rate compared with norepinephrine-only infusion (26.5% vs 35.7%; P = 0.05). An unpublished study comparing terlipressin (1.3 microg/kg/h), arginine vasopressin (0.03 U/min), and norepinephrine (15 microg/min) as first-line vasopressors showed that terlipressin had higher efficacy than arginine vasopressin in reducing catecholamine requirements. Current literature suggests that early infusion of low-dose continuous arginine vasopressin or terlipressin appears superior to a last-resort treatment. However, because no large clinical trials have proven terlipressin's safety in patients with septic shock, arginine vasopressin is preferred until more data are available.
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|Titolo:||Current place of vasopressin analogues in the treatment of septic shock|
|Data di pubblicazione:||2008|
|Appartiene alla tipologia:||01a Articolo in rivista|