Vasopressin Deficiency Contributes to the Vasodilation of Septic Shock
Abstract
Background The hypotension of septic shock is due to systemic vasodilation. On the basis of a clinical observation, we investigated the possibility that a deficiency in vasopressin contributes to the vasodilation of septic shock. Methods and Results In 19 patients with vasodilatory septic shock (systolic arterial pressure [SAP] of 92±2 mm Hg [mean±SE], cardiac output [CO] of 6.8±0.7 L/min) who were receiving catecholamines, plasma vasopressin averaged 3.1±1.0 pg/mL. In 12 patients with cardiogenic shock (SAP, 99±7 mm Hg; CO, 3.5±0.9 L/min) who were also receiving catecholamines, it averaged 22.7±2.2 pg/mL ( P <.001). A constant infusion of exogenous vasopressin to 2 patients with septic shock resulted in the expected plasma concentration, indicating that catabolism of vasopressin is not increased in this condition. Although vasopressin is a weak pressor in normal subjects, its administration at 0.04 U/min to 10 patients with septic shock who were receiving catecholamines increased arterial pressure (systolic/diastolic) from 92/52 to 146/66 mm Hg ( P <.001/ P <.05) due to peripheral vasoconstriction (systemic vascular resistance increased from 644 to 1187 dyne·s/cm 5 ; P <.001). Furthermore, in 6 patients with septic shock who were receiving vasopressin as the sole pressor, vasopressin withdrawal resulted in hypotension (SAP, 83±3 mm Hg), and vasopressin administration at 0.01 U/min, which resulted in a plasma concentration (≈30 pg/mL) expected for the level of hypotension, increased SAP from 83 to 115 mm Hg ( P <.01). Conclusions Vasopressin plasma levels are inappropriately low in vasodilatory shock, most likely because of impaired baroreflex-mediated secretion. The deficiency in vasopressin contributes to the hypotension of vasodilatory septic shock.
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We identified direct evidence from 13 studies (1,968 patients), including one RCT, on antimicrobial de-escalation.
“We identified direct evidence from 13 studies (1,968 patients) (277), including one RCT (278).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [278]
Landry and colleagues demonstrated that vasopressin levels were lower in adults with refractory vasodilatory septic shock.
“The rationale for using vasopressin as a therapy to treat refractory hypotension originated from the research produced by Landry and colleagues, which demonstrated that vasopressin levels were lower in adults with refractory vasodilatory septic shock [16].”
From Management of the Low Cardiac Output Syndrome Following Surgery for Congenital Heart Disease (2016) · cites this paper as [16]
Vasopressin concentration is elevated in early septic shock but decreases to normal range in most patients between 24 and 48 hours as shock continues.
“Studies show that vasopressin concentration is elevated in early septic shock but decreases to normal range in the majority of patients between 24 and 48 h as shock continues [352, 353].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [353]
Several meta-analyses suggest decreased mortality in patients with a pressure- and volume-limited strategy for established ARDS.
“Several meta-analyses suggest decreased mortality in patients with a pressure- and volume-limited strategy for established ARDS [353, 354].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [353]
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- Authors
- Landry, D. W., Levin, H. R., Gallant, E. M., Ashton, R. C., Seo, S., D'Alessandro, D., Oz, M. C., & Oliver, J. A.
- Affiliations
- Allegheny General Hospital (US)
- the Departments of Medicine (D.W.L., H.R.L., E.M.G., S.S., J.A.O.) and Surgery (D.D., M.C.O.), Columbia University, College of Physicians & Surgeons, New York, NY, and the Department of Surgery (R.C.A.), Allegheny General Hospital, Pittsburgh, Pa.
- Venue
- Circulation
- Published
- 1997-03-04
- Volume
- 95
- Issue
- 5
- Pages
- 1122-1125
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2062054105
- Cited by
- 990
- References
- 26
- Citations by year
- 2026: 28 · 2025: 29 · 2024: 31 · 2023: 27 · 2022: 22 · 2021: 22 · 2020: 30 · 2019: 26 · 2018: 34 · 2017: 29 · 2016: 25 · 2015: 21 · 2014: 22 · 2013: 32 · 2012: 33
- FWCI
- 11.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Keywords
- vasopressin deficiency, septic shock, vasodilation, hypotension, baroreflex, vasopressin infusion, systemic vascular resistance, catecholamines, cardiogenic shock
- MeSH terms
- Adult, Blood Pressure, Cardiac Output, Dopamine, Epinephrine, Heart Rate, Hemodynamics, Humans, Norepinephrine, Shock, Cardiogenic, Shock, Septic, Sodium, Vascular Resistance, Vasodilation, Vasopressins
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