The Effects of Vasopressin on Systemic and Splanchnic Hemodynamics and Metabolism in Endotoxin Shock

• Published in: Anesthesia and analgesia Vol. 97; no. 6; pp. 1756 - 1763
• Main Authors: Martikainen, Tero J, Tenhunen, Jyrki J, Uusaro, Ari, Ruokonen, Esko
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.12.2003; Lippincott
• Subjects: Animals; Biological and medical sciences; Blood Gas Analysis; Blood Volume - drug effects; Blood Volume - physiology; Cardiovascular system; Endotoxins - toxicity; Female; Fluid Therapy; Hemodynamics - drug effects; Lactic Acid - blood; Liver Circulation - drug effects; Medical sciences; Microdialysis; Miscellaneous; Norepinephrine - metabolism; Oxygen Consumption - drug effects; Pharmacology. Drug treatments; Regional Blood Flow - drug effects; Regional Blood Flow - physiology; Shock, Septic - metabolism; Shock, Septic - physiopathology; Splanchnic Circulation - drug effects; Swine; Vasopressins - pharmacology; Shock; Splanchnic region; Cardiovascular disease; Catecholamine; Metabolism; Endotoxin; Vasopressin; Pig; Infection; Toxin; Vertebrata; Chemotherapy; Mammalia; Treatment; Animal; Vasoconstrictor agent; Norepinephrine; Artiodactyla; Hemodynamics; Ungulata; Comparative study
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/01.ANE.0000087039.60041.2E

We compared the effects of vasopressin and norepinephrine on systemic and splanchnic circulation and metabolism in endotoxin shock in pigs. Twenty-one pigs were randomized to endotoxin shock (Escherichia coli endotoxin infusion) (n = 6), endotoxin and vasopressin (VASO; n = 6), endotoxin and norepinephrine (NE; n = 6), and controls (n = 3). Endotoxin infusion was increased to induce hypotension, after which vasopressin or norepinephrine was started to keep systemic mean arterial blood pressure >70 mm Hg. Regional blood flows and arterial and regional lactate concentrations were measured. Tonometers with microdialysis capillaries were inserted into the stomach, jejunum, and colon. Systemic mean arterial blood pressure >70 mm Hg was achieved in the VASO and NE groups. Vasopressin decreased cardiac output, superior mesenteric artery, and portal vein blood flow, whereas hepatic arterial blood flow increased. Arterial lactate concentration increased from 2.0 mM (1.6–2.1 mM) to 4.7 mM (4.7–4.9 mM) (P = 0.007). Systemic and mesenteric oxygen delivery and consumption decreased and oxygen extraction increased in the VASO group. Vasopressin increased mucosal-arterial Pco2 gradients in all three locations, whereas luminal lactate release occurred only in the jejunum. Animals in the NE group remained stable. Vasopressin reversed hypotension but decreased systemic and gut blood flow. This was associated with hyperlactatemia, signs of visceral dysoxia, and jejunal luminal lactate release.