Comparative study between vasopressin, norepinephrine, or a combination of both in patients with blood disease who developed septic shock

Nour El-Hoda N. Abu-Elnasr¹, Wafaa G. Ahmed¹, Salwa Abd El H. Mohamed¹, Fadia H. Elnekhely^2
1 Department of Anesthesia and Intensive Care, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
² Department of Internal Medicine and Hematology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt

Correspondence Address:
Wafaa G. Ahmed
MD, Department of Anesthesia and Intensive Care, Faculty of Medicine for Girls, Al-Azhar University, 59293 Cairo
Egypt

Source of Support: None, Conflict of Interest: None

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DOI: 10.7123/01.ASJA.0000417551.97450.76

The administration of arginine vasopressin (AVP) may be effective for hemodynamic support in septic shock. The aim of the present study is to compare the effect of continuous infusions of AVP, norepinephrine, or a AVP/norepinephrine combination for 48 h, when given as a hemodynamic supportive therapy in patients with blood diseases who developed septic shock and to compare the side effects, especially organ dysfunction.

The study included 54 patients with different blood diseases who developed septic shock; their mean arterial pressure was less than 60 mmHg or the systolic blood pressure was less than 90 mmHg, although adequate fluids had been administered. Patients were randomly allocated according to the drug infusion into three equal groups, with 18 patients in each group. The first group received AVP at 0.06 IU/min (group 1), the second group received 15 μg/min of norepinephrine (group 2), and AVP was infused at 0.03 IU/min combined with 10 μg/min of norepinephrine in the third group (group 3). For all the groups, norepinephrine could be added to achieve a mean arterial pressure between 65 and 75 mmHg if necessary. The hemodynamic response, laboratory and organ function, AVP level, and norepinephrine requirements as well as adverse events were recorded.

Blood pressure increased significantly in the three study groups throughout the study period (P<0.05), whereas the heart rate was significantly lower in group 1 and group 3 than in group 2 (P<0.05). Central venous pressure was insignificantly decreased in the three treatment groups throughout the study period (P=0.20). Plasma AVP levels were low in all groups at the baseline (P=0.35). These levels did not change in group 2, but increased in group 1 and group 3 at 24 and 48 h after drug infusion (P=0.001 and 0.001, respectively). Serum lactate levels and base deficit decreased significantly (P=0.002 and 0.001, respectively), whereas arterial pH increased significantly in the three study groups (P<0.05). The plasma creatinine concentration increased insignificantly in group 1 and group 2 over the 48-h intervention period as compared with group 3, in which the creatinine level did not change (P=0.45). Patients in group 1 had lower plasma troponin levels than patients in the other two groups (P=0.001). Platelets decreased in group 1 and group 3, but the decrease was only significant in group 1 (P=0.001). It showed a nonsignificant change in group 2 (P>0.05). We did not have to administer norepinephrine to any patient in the three study groups. There was no difference in the rate of serious adverse events between group 1 and group 2 (the rate was 5% in both the groups). One patient in the norepinephrine group had a cardiac arrest, whereas hyponatremia was recorded in group 1; no adverse events were recorded in group 3.

The present study provides evidence that a continuous infusion of low-dose AVP 0.03 IU/min in combination with 10 μg/min of norepinephrine is effective in septic shock, with less complications, especially renal and liver dysfunction and platelet disorder. These findings indicate that this combination is suitable for use in high-risk hematological patients with septic shock.