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. 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; 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.
 Delmas et al, Crit Care April 2005 Vol 9 N2
 Landry et al, Circulation1997;95:1122–5
 Gordon et al, BMJ Open November 25-2015
 Russell et al, NEJM 2008;358:877–87
Full text from Critical Care