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Critical Care
Published in: Critical Care 5/2013

01-10-2013 | Commentary

On sepsis, troponin and vasopressin: the bitter truth

Authors: Ilse Gradwohl-Matis, Martin W Dünser

Published in: Critical Care | Issue 5/2013

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Abstract

One of the rationales for the use of vasopressin in septic shock has been its potential cardioprotective mechanisms. Lower heart rates, higher arterial pressures, and fewer norepinephrine doses during vasopressin therapy were hypothesized to protect the heart from myocardial ischemia. In a prospective sub-study of the VASST (Vasopressin in Septic Shock Trial) project, Mehta and colleagues specifically evaluated this hypothesis but failed to find lower cardiac biomarkers or fewer ischemic electrocardiogram changes in patients receiving vasopressin compared with subjects receiving norepinephrine alone. After recent evidence of a lacking survival benefit, the present study results further challenge the future role of vasopressin as a vasopressor in septic shock.
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Literature
1.
Mehta S, Granton J, Gordon AC, Cook DJ, Lapinsky S, Newton G, Bandayrel K, Little A, Siau C, Ayers D, Singer J, Lee TC, Walley KR, Storms M, Cooper JD, Holmes CL, Hebert P, Presneill J, Russell JA: Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine. Crit Care 2013, 17: R117. 10.1186/cc12789PubMedCentralCrossRefPubMed
2.
Russell JA, Walley KR, Singer J, Gordon AC, Hébert PC, Cooper DJ, Holmes CL, Mehta S, Granton JT, Storms MM, Cook DJ, Presneill JJ, Ayers D, VASST Investigators: Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 2008, 358: 877-887. 10.1056/NEJMoa067373CrossRefPubMed
3.
Polito A, Parisini E, Ricci Z, Picardo S, Annane D: Vasopressin for treatment of vasodilatory shock: an ESICM systematic review and meta-analysis. Intensive Care Med 2012, 38: 9-19. 10.1007/s00134-011-2407-xCrossRefPubMed
4.
Dünser MW, Hasibeder WR: Vasopressin in vasodilatory shock: ensure organ blood flow, but take care of the heart! Crit Care 2006, 10: 172. 10.1186/cc5089PubMedCentralCrossRefPubMed
5.
6.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013, 39: 165-228. 10.1007/s00134-012-2769-8CrossRefPubMed
7.
Dünser MW, Ruokonen E, Pettilä V, Ulmer H, Torgersen C, Schmittinger CA, Jakob S, Takala J: Association of arterial blood pressure and vasopressor load with septic shock mortality: a post hoc analysis of a multicenter trial. Crit Care 2009, 13: R181. 10.1186/cc8167PubMedCentralCrossRefPubMed
8.
Dünser MW, Mayr AJ, Tür A, Pajk W, Barbara F, Knotzer H, Ulmer H, Hasibeder WR: Ischemic skin lesions as a complication of continuous vasopressin infusion in catecholamine-resistant vasodilatory shock: incidence and risk factors. Crit Care Med 2003, 31: 1394-1398. 10.1097/01.CCM.0000059722.94182.79CrossRefPubMed
9.
Dünser MW, Mayr AJ, Stallinger A, Ulmer H, Ritsch N, Knotzer H, Pajk W, Mutz NJ, Hasibeder WR: Cardiac performance during vasopressin infusion in postcardiotomy shock. Intensive Care Med 2002, 28: 746-751. 10.1007/s00134-002-1265-yCrossRefPubMed
10.
Hajjar L, Vincent JL, Rhodes A, Annane D, Galas F, Almeida J, Zeferino S, Camara L, Santos V, Pereira J, Osawa E, Maciel E, Rodrigues A, Jardim J, Blini D, Araujo E, Bergamin F, Kalil Filho R, Auler J Jr: Vasopressin Versus Norepinephrine for the Management of Shock After Cardiac Surgery (VaNCS study): a randomized controlled trial. Crit Care 2013,17(Suppl 2):P222.PubMedCentral
11.
Papadopoulos G, Sintou E, Siminelakis S, Koletsis E, Baikoussis NG, Apostolakis E: Perioperative infusion of low- dose of vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-A double-blind randomized study. J Cardiothorac Surg 2010, 5: 17. 10.1186/1749-8090-5-17PubMedCentralCrossRefPubMed
12.
Luckner G, Dünser MW, Jochberger S, Mayr VD, Wenzel V, Ulmer H, Schmid S, Knotzer H, Pajk W, Hasibeder W, Mayr AJ, Friesenecker B: Arginine vasopressin in 316 patients with advanced vasodilatory shock. Crit Care Med 2005, 33: 2659-2666. 10.1097/01.CCM.0000186749.34028.40CrossRefPubMed
13.
Bauer A, Kofler S, Thiel M, Eifert S, Christ F: Monitoring of the sublingual microcirculation in cardiac surgery using orthogonal polarization spectral imaging: preliminary results. Anesthesiology 2007, 107: 939-945. 10.1097/01.anes.0000291442.69337.c9CrossRefPubMed
14.
Dünser MW, Takala J, Brunauer A, Bakker J: Re-thinking resuscitation: leaving blood pressure cosmetics behind and moving forward to permissive hypotension and a tissue perfusion-based approach. Crit Care 2013, 17: 326.PubMedCentralCrossRefPubMed
Metadata
Title
On sepsis, troponin and vasopressin: the bitter truth
Authors
Ilse Gradwohl-Matis
Martin W Dünser
Publication date
01-10-2013
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2013
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc12772

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