The effect of vasopressin on gastric perfusion in catecholamine-dependent patients in septic shock.

Abstract

OBJECTIVE: To study the effect of continuous infusion of vasopressin on the splanchnic circulation in patients with severe septic shock. DESIGN: Prospective clinical study. SETTING: ICU in a teaching hospital. PATIENTS: Eleven consecutive patients with documented septic shock who remained hypotensive despite norepinephrine infusion at a rate > or =0.2 microg/kg/min. INTERVENTIONS: Insertion of a gastric tonometry catheter, and continuous infusion of vasopressin 0.04 U/min during 4 h. MEASUREMENTS AND MAIN RESULTS: Difference between gastric and arterial CO(2) partial pressure (P[g-a]CO(2) gap), mean arterial pressure, and cardiac index were recorded at baseline and after 15 min, 30 min, 60 min, 120 min, and 240 min. RESULTS: The median P(g-a)CO(2) gap increased from 5 mm Hg at baseline to 19 mm Hg after 4 h (p = 0.022). Mean arterial pressure increased from 61 +/- 13 mm Hg at baseline to 68 +/- 9 mm Hg after 4 h (p = 0.055). No significant changes in cardiac index were noted. CONCLUSIONS: In norepinephrine-dependent patients in septic shock, continuous infusion of low-dose vasopressin results in a significant increase of the P(g-a)CO(2) gap compatible with GI hypoperfusion.