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Published ahead of print on June 5, 2003, doi:10.1164/rccm.200205-447OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 4, August 2003, 481-486

A more recent version of this article appeared on August 15, 2003
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Submitted on May 30, 2002
Accepted on May 22, 2003

LOW DOSE VASOPRESSIN IN THE TREATMENT OF SEPTIC SHOCK IN SHEEP

Qinghua Sun1, George Dimopoulos1, Duc Nam Nguyen1, Zizhi Tu1, Nathalie Nagy1, Anh Dung Hoang1, Peter Rogiers1, Daniel De Backer1, and Jean-Louis Vincent*

1 Intensive Care, Erasme University Hospital, Brussels, Belgium

* To whom correspondence should be addressed. E-mail: jlvincen{at}ulb.ac.be.

Following induction of cecal perforation, twenty anesthetized sheep were randomized to be treated, when arterial blood pressure fell below 75 mmHg, with vasopressin (fixed dose of 0.02 U/min), norepinephrine (0.5-5 µg/kg/min titrated to maintain mean arterial pressure between 75-85 mmHg), vasopressin + norepinephrine (vasopressin at fixed dose 0.01 U/min, plus norepinephrine titrated as for norepinephrine only group), or no vasopressor (Ringer's lactate [control]). Mean arterial pressure was well maintained in all treatment groups. Superior mesenteric arterial blood flow was significantly lower in vasopressin + norepinephrine groups than in the vasopressin group. Vasopressin alone or combined with norepinephrine limited the increase in blood lactate concentration and ileal PCO2-gap compared with control and norepinephrine groups. Urine output was higher in the vasopressin group than in control and norepinephrine groups. Survival time was longer in the vasopressin (30±6h) and vasopressin + norepinephrine (30±3h) than in the norepinephrine group (20±1h, p<. 05), and in all treatment groups than in the control group (17±2 h, p<. 05). Tissue injury was less severe in the vasopressin and vasopressin + norepinephrine groups than in the others. In this clinically relevant model of septic shock due to peritonitis, vasopressin administration (alone or with norepinephrine) can prolong survival.
Key words: norepinephrine; peritonitis; sheep; survival time; histologic abnormality




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