Two-component vasopressor therapy for septic shock
https://doi.org/10.21292/2078-5658-2021-18-1-57-64
Abstract
The objective: to investigate the efficacy and safety of terlipressin when it is used as an additional vasopressor in septic shock.
Subjects: A single-center, observational, retrospective-prospective study of the efficacy and safety of combined therapy of septic shock with norepinephrine and terlipressin versus monotherapy with norepinephrine was conducted.
Results. The use of terlipressin made it possible to reduce the average daily need for noradrenaline in patients with septic shock from 0.68 μg · kg-1 · min-1 in the control group to 0.55 μg · kg-1 · min-1 in the study group (p = 0.015) and reduce the duration of vasopressor support from 8 days [6.0-11.0] to 6 days [5.0-8.0] in the study group (p = 0.023). The use of terlipressin did not reduce the need for mechanical ventilation, but it did reduce the duration of ventilation. The number of days free from mechanical ventilation in patients in the control group was 6.0 [1.0-18.0], in the study group - 16.0 [2.0-22.0], (p = 0.039).
Conclusion. The use of terlipressin as a supplement to norepinephrine is an effective and relatively safe treatment for hypotension in refractory septic shock.
About the Authors
A. A. Kochkin
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation
Russian Federation
Aleksandr A. Kochkin Researcher of Intensive Care Department
61/2, Schepkina St., Moscow, 129110
Phone/Fax: +7 (495) 929‒58‒04
V. V. Likhvantsev
M. F. Vladimirsky Moscow Regional Research Clinical Institute; V. A. Negovsky Scientific Research Institute of General Reanimatology
Russian Federation
Russian Federation
Valeriy V. Likhvantsev Doctor of Medical Sciences, Professor, Head Researcher of Anesthesiology and Intensive Care Department
61/2, Schepkina St., Moscow, 129110
Phone: +7 (495) 694‒65‒05
К. К. Kadantseva
V. A. Negovsky Scientific Research Institute of General Reanimatology; A. S. Loginov Moscow Clinical Scientific Center
Russian Federation
Russian Federation
Kristina K. Kadantseva V.A. Negovsky Scientific Research Institute of General Reanimatology, Researcher of the Laboratory of Organ Protection in Critical States
Phone/Fax: +7 (495) 641‒30‒06
References
1. Аvdeykin S.N., Tyurin I.N., Kozlov I.А. Management of hemodynamics in severe community acquired pneumonia, complicated by acute respiratory distress syndrome. Meditsinsky Alfavit. 2018, vol. 18, no. 2, pp. 19-26. (In Russ.) ISSN: 2078-5631.
2. Dmitrieva N.V., Petukhova I.N., Gromova E.G. Sepsis: izbrannyye voprosy diagnostiki i lecheniya. [Sepsis: selected issues of diagnosis and treatment]. Moscow, ID ABVPress Publ., 2018, 416 p. ISBN: 978-5-903018-55-0.
3. Ilyina Ya.Yu., Fot E.V., Izotova N.N. et al. Dynamic tests for assessing susceptibility to infusion load in septic shock. Anesteziologiya i Reanimatologiya, 2018, vol. 63, no. 2, pp. 108-112. (In Russ.) doi: 10.18821/0201-7563-2018-63-2-108-112.
4. Intensivnaya terapiya. Natsionalnoye rukovodstvo: v 2 t. [Intensive care. National guidelines. 2 volumes]. I.B. Zabolotskikh, D.N. Protsenko, eds., 2nd edition, reviewed and supplemented. Moscow, GEOTAR-Media Publ., 2020, vol. 2, 1056 p. ISBN: 978-5-9704-5018-5.
5. Rudnov V.А., Kulabukhov V.V. Sepsis-3: updated main definitions, potential problems and next practical steps. Messenger of Anesthesiology and Resuscitation, 2016, vol. 13, no. 4, pp. 4-11. (In Russ.) doi: 10.21292/2078-5658-2016-13-4-4-11.
6. Sapicheva Yu.Yu., Likhvantsev V.V., Petrovskaya E.L. et al. Taktika vedeniya patsiyentov s sepsisom i septicheskim shokom v mnogoprofilnom statsionare. [Management of patients with sepsis and septic shock in a multidisciplinary hospital]. Moscow, 2015, 35 p. ISBN: 978-5-98511-299-3.
7. Sepsis: klassifikatsiya, kliniko-diagnosticheskaya kontseptsiya i lecheniye. [Sepsis: classification, clinical and diagnostic concept and treatment]. Academician of RAS, B.R. Gelfand, eds., 4th ed., reviewed and supplemented. Moscow, OOO Meditsinskoye Informatsionnoye Agentstvo Publ., 2017, ISBN: 978 (-5) -8948-1988-4.
8. Tyurin I.N., Аvdeykin S.N., Protsenko D.N. et al. Epidemiology of sepsis in patients admitted to the intensive care unit of a multi-specialty hospital. Obschaya Reanimatologiya, 2019, vol. 15, no. 4, pp. 42-57. (In Russ.) doi: 10.15360/1813-9779-2019-4-42-57.
9. Arslantas M.K., Gul F., Kararmaz A. et al. Early administration of low dose norepinephrine for the prevention of organ dysfunctions in patients with sepsis. Intens. Care Med., Exp. 2015, vol. 3, no. 1, pp. 417‒418. doi: 10.1186/2197-425X-3-S1-A417.
10. Asfar P., Meziani F., Hamel J. et al. High versus low blood-pressure targets in patients with septic shock. N. Engl. J. Med., 2014, vol. 370, no. 17, pp. 1583–1593. doi: 10.1056/NEJMoa1312173.
11. Auchet T., Regnier M.-A., Girerd N. et al. Outcome of patients with septic shock and high-dose vasopressor therapy. Ann. Intens. Care, 2017, vol. 7, pp. 43‒51. doi: 10.1186/s13613-017-0261-x.
12. Bassi E., Park M., Azevedo L. C. Therapeutic strategies for high-dose vasopressor-dependent shock. Crit. Care Res. Pract., 2013, Article ID 654708, 10 p. doi: 10.1155/2013/654708.
13. Beurton A., Ducrocq N., Auchet T. et al. Beneficial effects of norepinephrine alone on cardiovascular function and tissue oxygenation in a pig model of cardiogenic shock. Shock, 2016, vol. 46, no. 2, pp. 214–218. doi: 10.1097/SHK.0000000000000579.
14. Burgdorff A.M., Bucher M., Schumann J. Vasoplegia in patients with sepsis and septic shock: pathways and mechanisms. J. Int. Med. Res., 2018, vol. 46, no. 4, pp. 1303–1310. doi: 10.1177/0300060517743836.
15. Colling K.P., Banton K.L., Beilman G.J. Vasopressors in sepsis. Surgical Infect., 2018, vol. 19, no. 2, pp. 202‒207. doi:10.1089/sur.2017.255.
16. Jentzer J.C., Coons J.C., Link C.B. et al. Pharmacotherapy update on the use of vasopressors and inotropes in the intensive care unit. J. Cardiovasc. Pharmacol. Ther., 2015, vol. 20, no. 3, pp. 249‒260. doi: 10.1177/1074248414559838.
17. Khanna A., English S. W., Wang X. S. et al. Angiotensin II for the treatment of vasodilatory shock. // N. Engl. J. Med. – 2017. – Vol. 377. – P. 419‒430. doi: 10.1056/NEJMoa1704154.
18. Kimmoun A., Ducrocq N., Levy B. Mechanisms of vascular hyporesponsiveness in septic shock // Curr. Vasc. Pharmacol. – 2013. – Vol. 11. – P. 139‒149. doi: 10.1186/s13054-018-1967-3.
19. Lambden S., Creagh-Brown Ben C., Hunt J. et al. Definitions and pathophysiology of vasoplegic shock // Crit. Care. – 2018. – Vol. 22. – P. 174-182. doi: 10.1186/s13054-018-2102-1.
20. Leone M., Asfar P., Radermacher P. et al. Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature // Crit. Care. – 2015. – Vol. 19. – P. 101‒107. doi:10.1186/s13054-015-0794-z.
21. Rhodes A., Evans L., Alhazzani W. et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016 // Int. Care Med. ‒ 2017. ‒ Vol. 43. ‒ Р. 304–377. doi: 10.1007/s00134-017-4683-6.
22. Sepra N., Nassar A. P., Cardoso S. O. et al. Vasopressin and terlipressin in adult vasodilatory shock: a systematic review and metaanalysis of nine randomized controlled trials // Crit. Care. – 2012. – Vol. 16. – P. 154‒164. doi: 10.1186/cc11469.
23. Shankar-Hari M., Phillips G. S., Levy M. L. et al. Developing a new definition and assessing new clinical criteria for septic shock for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) // JAMA. ‒ 2016. ‒ Vol. 315, № 8. ‒ Р. 775‒787. doi: 10.1001/jama.2016.0289.
24. Svoboda P., Scheer P., Kantorova I. et al. Terlipressin in the treatment of late phase catecholamine-resistant septic shock // Hepato-gastroenterology. – 2012. – Vol. 59, № 116. – P. 1043–1047. doi: 10.5754/hge10550.
25. Vincent J-L., De Backer D. Circulatory shock // N. Engl. J. Med. – 2013. – Vol. 369, № 18. – P. 1726–1734. doi:10.1056/NEJMra1208943.
26. Xiao X., Zhang J., Wang Y. et al. Effects of terlipressin on patients with sepsis via improving tissue blood flow // J. Surgical Res. – 2016. – Vol. 200, № 1. – P. 274‒282. doi: 10.1186/s12871-020-00965-4.
Review
For citations:
Kochkin A.A., Likhvantsev V.V., Kadantseva К.К. Two-component vasopressor therapy for septic shock. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2021;18(1):57-64. (In Russ.) https://doi.org/10.21292/2078-5658-2021-18-1-57-64
Email this article 