Vasopressin for vasopressor-dependent septic shock

Few clinical trials have directly compared vasoactive treatments of septic shock for their impact on morbidity and mortality. Traditional treatment for refractory hypotension has remained relatively unchanged for several decades; catecholamines—including norepinephrine, epinephrine, phenylephrine, dopamine, and dobutamine—are the standard treatments used to maintain perfusion pressure.1,2 Recently, because of the resistance to catecholamines during septic shock, attention has turned toward the use of the noncatecholamine agent vasopressin.3 Vasopressin is emerging as a viable first-line treatment option for improving hemodynamics and decreasing catecholamine requirements in refractory septic shock. Our article discusses the dosage, efficacy, and safety of vasopressin therapy for vasopressor-dependent septic shock. The most common and most frequently studied cause of vasodilatory shock is sepsis. Septic shock requires prompt attention and appropriate treatment. In November 2004, guidelines for the management of severe sepsis and septic shock were published by the Surviving Sepsis Campaign, an international group of experts on critical care and infectious diseases.2 The purpose of the guidelines was to improve outcomes in patients with septic shock by providing a standardized management approach. According to the guidelines, initial treatment should include broad-spectrum antibiotic therapy and fluid resuscitation. Appropriate minimum hemodynamic goals consist of a central venous pressure of 8–12 mm Hg, a mean arterial pressure (MAP) of 65 mm Hg, urine output of 0.5 mL/kg/hr, and central venous oxygen saturation of 70%. In many cases, fluid resuscitation alone will not maintain MAPs above 65 mm Hg; therefore, the addition of a catecholamine or noncatecholamine vasoactive agent must be considered.