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Comparative Study
. 2006;10(3):R71.
doi: 10.1186/cc4917. Epub 2006 May 5.

Arginine-vasopressin in catecholamine-refractory septic versus non-septic shock in extremely low birth weight infants with acute renal injury

Sascha Meyer  1 , Sven Gottschling, Ali Baghai, Donald Wurm, Ludwig Gortner
Affiliations
Comparative Study

Arginine-vasopressin in catecholamine-refractory septic versus non-septic shock in extremely low birth weight infants with acute renal injury

Sascha Meyer et al. Crit Care. 2006.

Abstract

Introduction: The aim of this study was to assess the efficacy of arginine-vasopressin (AVP) as a rescue therapy in catecholamine-refractory septic and non-septic shock in extremely low birth weight (ELBW) infants with acute renal injury.

Methods: Prospective assessment of AVP therapy in three ELBW infants with catecholamine-refractory septic shock and acute renal injury (mean birth weight 600 +/- 30 g) and three ELBW infants with non-septic shock and acute renal injury (mean birth weight 770 +/- 110 g) at a University hospital. The main outcome measures were restoration of blood pressure with adequate organ perfusion and survival at discharge.

Results: In all three ELBW infants with catecholamine-resistant septic shock, systemic arterial blood pressure increased substantively with restoration of urine output after AVP administration (dosage, 0.035 to 0.36 U/kg/h; length, 70 +/- 21 hours). In the three ELBW infants with non-septic shock, only a transient stabilization in mean arterial pressure with restoration of urine output was observed after AVP therapy (dosage, 0.01 to 0.36 U/kg/h; length, 30 +/- 16 hours). The mortality rate was 1/3 in the sepsis group versus 3/3 in the non-septic group.

Conclusion: AVP may be a promising rescue therapy in catecholamine-resistant shock in ELBW infants with acute renal injury. Larger prospective clinical trials are warranted to assess the efficacy and safety of AVP as a pressor adjunct in septic versus non-septic shock in ELBW infants.

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Figures

Figure 1
Figure 1
Cardiovascular parameters and urine output and serum lactate in ELBW infants with sepsis before and after initiation of arginine-vasopressin therapy. (a) Cardiovascular parameters: columns show mean arterial blood pressure (MAP; mmHg); lines show heart rate (beats per minute). Values given as mean ± standard deviation. (b) Urine output and serum lactate: columns show urine output (ml/kg body weight/h); lines show serum lactate (mmol/l). Values given as mean ± standard deviation.
Figure 2
Figure 2
Cardiovascular parameters and urine output and serum lactate in ELBW infants with sepsis before and after initiation of arginine-vasopressin therapy. (a) Cardiovascular parameters: columns show mean arterial blood pressure (MAP; mmHg); lines show heart rate (beats per minute). Values given as mean ± standard deviation. (b) Urine output and serum lactate: columns show urine output (ml/kg body weight/h); lines show serum lactate (mmol/l). Values given as mean ± standard deviation.
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