Arginine vasopressin in septic shock: supplement or substitute for norepinephrine?
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* Corresponding author: Sebastian Rehberg serehber@utmb.edu
1 Investigational Intensive Care Unit, Department of Anesthesiology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA
2 Department of Anesthesiology and Intensive Care, University of Muenster, Albert-Schweitzer-Str. 33, 48149 Muenster, Germany
Critical Care 2009, 13:178 doi:10.1186/cc7985
Published: 14 August 2009Abstract
In the current issue of Critical Care, Simon and coworkers investigated the effects of first-line arginine vasopressin (AVP) on organ function and systemic metabolism compared with norepinephrine in a pig model of fecal peritonitis. AVP was titrated according to the mean arterial pressure suggesting a vasopressor rather than a hormone replacement therapy. The study provides some evidence for the safety of this therapeutic approach. It needs to be determined whether AVP is most beneficial as a constant low-dose infusion to supplement norepinephrine or in higher doses than currently recommended to substitute norepinephrine. In addition, future studies are warranted to evaluate whether a first-line therapy of AVP is superior to a last-resort administration.