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01.04.2004 | Original

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

verfasst von: Andrea Morelli, Monica Rocco, Giorgio Conti, Alessandra Orecchioni, Andrea De Gaetano, Giuliana Cortese, Flaminia Coluzzi, Enrico Vernaglione, Paolo Pelaia, Paolo Pietropaoli

Erschienen in: Intensive Care Medicine | Ausgabe 4/2004

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Abstract

Objectives

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.

Design

Prospective open label study.

Settings

Two multidisciplinary intensive care units.

Patients

Fifteen patients with norepinephrine-treated septic shock.

Interventions

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.

Measurements and main results

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 PCO₂ 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).

Conclusions

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.

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Titel: Effects of terlipressin on systemic and regional haemodynamics in catecholamine-treated hyperkinetic septic shock
verfasst von: Andrea Morelli
Monica Rocco
Giorgio Conti
Alessandra Orecchioni
Andrea De Gaetano
Giuliana Cortese
Flaminia Coluzzi
Enrico Vernaglione
Paolo Pelaia
Paolo Pietropaoli
Publikationsdatum: 01.04.2004
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 4/2004
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-2094-3

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