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Effects of terlipressin on systemic and regional haemodynamics in catecholamine-treated hyperkinetic septic shock.

Research paper by Andrea A Morelli, Monica M Rocco, Giorgio G Conti, Alessandra A Orecchioni, Andrea A De Gaetano, Giuliana G Cortese, Flaminia F Coluzzi, Enrico E Vernaglione, Paolo P Pelaia, Paolo P Pietropaoli

Indexed on: 16 Dec '03Published on: 16 Dec '03Published in: Intensive Care Medicine



Abstract

To determine the effects of an intravenous bolus dose of a vasopressin analogue, terlipressin (1 mg), on systemic haemodynamic parameters and gastric mucosal perfusion (GMP) in patients with catecholamine-treated septic shock using a gastric tonometry and laser-Doppler flowmetry technique.Prospective open label study.Two multidisciplinary intensive care units.Fifteen patients with norepinephrine-treated septic shock.Every patient with mean arterial pressure between 50 and 55 mmHg treated with high dose norepinephrine received an intravenous bolus dose of terlipressin as last resort therapy. A laser-Doppler probe and tonometer were introduced into the gastric lumen.Terlipressin produced a decrease in cardiac output ( p<0.05), a progressive increase in mean arterial pressure ( p<0.05) and in GMP, detected by laser-Doppler flowmetry ( p<0.05) over 30 min and sustained for at least 24 h. The ratio of GMP to systemic oxygen delivery increased after terlipressin bolus dose ( p<0.05). The gradient between gastric mucosal and arterial PCO(2) tended to be lower after terlipressin, and the difference was statistically significant ( p<0.05) after 8 h. Terlipressin administration significantly increased ( p<0.05) urine output compared to baseline and higher values were found at each set of measurement. The terlipressin-induced increase in urine output was associated with a significantly increased creatinine clearance ( p<0.05). Reduction of the high-dose norepinephrine was observed in all patients ( p<0.05).Our findings showed that, in patients with norepinephrine-treated septic shock, terlipressin increased GMP, urine output and creatinine clearance by an increase in mean arterial pressure.