L. Caneva, A. Casazza, E. Bellazzi, S. Marra, L. Pagani, M. Vetere, R. Vanzino, D. Ciprandi, R. Preda, R. Boschi, L. Carnevale

Crit Care 2016, 20 (Suppl 2), P049

Introduction: Low-dose vasopressin (VP) recently emerged as a promising therapy for septic shock[1]. The rationale for its use is the relative VP deficiency in patients with septic shock and VP ability to restore vascular tone and blood pressure, reducing the need for cathecolamines[2]; however VP outcome effects in septic patients remain unclear[3-4].

Methods: We retrospectively analyzed patients admitted to our general ICU for septic shock in the last 23 months (between 1/2014 and 11/2015) and treated with Norepinephrine (NE) or with the association NE + VP. Patients were treated with NE after adequate fluid expansion. VP was added (0.02-0.03U/min) in case of MAP < 60 mmHg with NE dosage > = 0,4mcg/kg/min. We analyzed severity scores and plasma lactates at ICU admission, mortality in ICU, urinary output during the first 24 hours of vasopressor and need for RRT during ICU stay. Mann-Whitney and Chi-Square tests were used for statistical analysis.

Results: 39 patients were enrolled, 15 patients received NE + VP (NV group), 24 received NE (NE group). Overall mortality rate was 46.1 %: 53.3 % in NV and 42 % in NE group respectively (p = 0,47). The need of RRT was greater in NV than in NE group (40vs20%, p = 0,19). Urinary output in the first 24 hours of vasopressor was lower in NV group (0,7vs1 ml/kg/h, p = 0,47). NV group patients had more severe haemodynamic impairment and also worse severity score (SOFA = 11,8vs9,9; p = 0,03), worse renal function (AKIN 3vs2) at ICU admission and higher plasma lactates levels (3,9vs3,6; p = 0,39) NV group had greater incidence of thrombocytopenia (105vs207, p = 0,03).

Conclusions: We didn’t find any statistically significant difference between NV and NE groups in ICU mortality, despite NV had a significantly higher predicted mortality according to the SOFA. Renal function impairment wasn’t significantly different in the two groups. The greater incidence of thrombocytopenia (p = 0.03) observed in NV group is in line with other studies.

References

[1] Delmas et al, Crit Care April 2005 Vol 9 N2

[2] Landry et al, Circulation1997;95:1122–5

[3] Gordon et al, BMJ Open November 25-2015

[4] Russell et al, NEJM 2008;358:877–87

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