(Circulation. 1997;95:1122-1125.)
© 1997 American Heart Association, Inc.
Articles |
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.
Correspondence to Donald W. Landry, MD, PhD, Columbia University, Department of Medicine, 630 W 168th St, New York, NY 10032.
| Abstract |
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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/cm5; 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.
Key Words: shock hypotension vasodilation
| Introduction |
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Abnormalities in vasoconstrictor mechanisms have been less well examined, but vascular smooth muscle is poorly responsive to norepinephrine in septic shock.4 5 In contrast, the renin-angiotensin system appears to be appropriately activated, and its inhibition worsens the hypotension of sepsis.6 Plasma endothelin is also elevated in septic shock, but the meaning of this observation is yet to be defined.7
Vasopressin does not play a significant role in the control of vascular smooth muscle in normal conditions8 9 10 11 12 13 but becomes critical when blood pressure is threatened.11 12 13 Vasopressin is markedly increased in animal models of acute sepsis,14 15 16 but we recently found that some patients in advanced vasodilatory septic shock are exquisitely sensitive to the pressor action of exogenous hormone (D.W.L., unpublished observation, 1994). This unexpected finding raised the possibility that endogenous plasma vasopressin is inappropriately low in these patients. Thus, we examined the hypothesis that vasopressin deficiency could contribute to the vasodilation of septic shock in humans.
| Methods |
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Septic shock was diagnosed by established criteria17 : hypotension (systolic blood pressure
90 mm Hg in the absence of antihypertensive agents) and low systemic vascular resistance (<800 dyne·s/cm5) before the administration of catecholamines; fever or hypothermia (temperature >101°F or <97°F); tachycardia (heart rate >90 beats/min); tachypnea (respiratory rate >20 breaths/min or the requirement of mechanical ventilation) and either a positive blood culture (63% of patients in the "Septic Shock" column of Table 1, 80
80% of patients in Table 2
) or an obvious source of infection (white blood cell count >12 000/mm3 or <4000/mm3 or >10% immature [band] forms); and elevated prothrombin or partial thromboplastin time or reduction of the platelet count to less than half the baseline or <100 000 platelets/mm3.
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In all septic patients, hypotension persisted after fluid administration (pulmonary capillary wedge pressure
12 mm Hg) and required administration of catecholamines (norepinephrine, epinephrine, dopamine, and/or neosynephrine) to maintain systolic blood pressure >90 mm Hg for 1 to 2 days. Arterial pressure was measured by transduction through an indwelling catheter and cardiac output by the thermodilution technique using a Swan-Ganz catheter in the pulmonary artery.
Cardiogenic shock was diagnosed by a systolic arterial pressure
90 mm Hg, pulmonary capillary wedge pressure >15 mm Hg, and cardiac index of
2 L/min before catecholamine administration18 ; patients with fever, hypothermia, or an obvious source of infection were excluded. All patients required catecholamines to maintain systolic blood pressure >90 mm Hg.
Plasma vasopressin was measured by radioimmunoassay using published protocols.19 For this assay, the reference range (95%) for hemodynamically normal subjects is <2.2 pg/mL for serum osmolality <285 mOsm/kg. Sensitivity was 0.3 pg per tube by dilution method.
Vasopressin (vasopressin injection USP, 8-arginine vasopressin) was administered into a central vein at 0.04 U/min (Table 1
). Intravenous fluids and medications were not changed for the hour before or the first hour of vasopressin administration except that during vasopressin administration, pressor catecholamines were decreased if systolic arterial pressure exceeded 130 mm Hg. Continuous measurements of systolic arterial pressure and heart rate were averaged in 15-minute intervals. In Table 2
, "Pre-AVP" values are averages of the hour preceding vasopressin; "AVP" values, from the first hour of vasopressin, are averages of the 15-minute interval in which systolic arterial pressure reached maximum value. In Fig 2
, vasopressin administration ("AVP") values are averages of the hour before or after discontinuation; the "No AVP" value is the average of the 15-minute interval during which systolic arterial pressure reached its minimum value. Data were analyzed by unpaired t test (Fig 2
) and paired t test (Table 2
and Fig 1
). Differences were termed significant if t>5%.
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| Results |
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To distinguish between increased metabolism of vasopressin versus decreased secretion, we measured plasma vasopressin during infusion of exogenous hormone in two patients with septic shock. At a constant infusion of 0.01 U/min, the steady-state plasma concentration increased to 27 and 34 pg/mL, values expected in subjects given this infusion rate.22 Thus, the low plasma vasopressin in patients with septic shock appears to be due to impaired hormone secretion.
Plasma sodium concentration was normal (mean, 140 mmol/L) in the patients with septic shock (Table 1
), and although the osmotically mediated secretion of vasopressin was not formally examined, no patient had clinical evidence of diabetes insipidus. This suggests that patients in septic shock have a specific inhibition of baroreflex-mediated secretion of vasopressin.
To examine whether vasopressin could constrict vascular smooth muscle in vasodilatory septic shock, 10 patients with this condition received vasopressin at 0.04 U/min IV. In normal subjects, significantly higher doses have little vasoconstrictor action9 and do not increase arterial pressure.9 10 In patients in septic shock, however, vasopressin increased systolic arterial pressure from 92 to 146 mm Hg (59% increase) due entirely to its vasoconstrictor effect. Whereas systemic vascular resistance increased 79%, cardiac output decreased 12% (Table 2
). The increase in pressure occurred within minutes (<15 minutes) of the administration of hormone and frequently required decreasing or stopping the concomitantly administered catecholamine. Furthermore, in 6 of 10 patients, arterial pressure was maintained on vasopressin alone.
Vasopressin at 0.04 U/min causes the plasma concentration to increase
100 pg/mL,22 which is substantially higher than the concentrations of 20 to 30 pg/mL that we found in the patients in cardiogenic shock (Fig 2
) and those that others have found for this degree of hypotension.20 21 To test whether this lower concentration could increase arterial pressure in septic shock, we infused the hormone at 0.01 U/min (shown above to provide a concentration of
30 pg/mL). Thus, in the six patients who were receiving vasopressin as the sole pressor, the hormone was stopped and within minutes, systolic arterial pressure declined from 126 to 83 mm Hg (P<.01) (Fig 2
). The subsequent administration of vasopressin at 0.01 U/min resulted in a significant and sustained increase in systolic arterial pressure from 83 to 115 mm Hg (P<.01). Although systemic vascular resistance was not measured in these patients, the acute increase in arterial pressure was due to vasoconstriction because vasopressin only decreases cardiac output (see Table 2
and Reference 9).
| Discussion |
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The reason for impaired baroreflex-mediated vasopressin secretion in septic shock is unknown. First, autonomic failure is a possibility. Deficient baroreflex-mediated secretion of vasopressin is well documented in primary autonomic failure,23 24 and sympathetic function appears to be impaired in septic shock.25 In support of autonomic dysfunction in our patients with septic shock, vasopressin did not cause the marked bradycardia observed under normal conditions (Table 2
).23 26
A second potential explanation for inappropriately low vasopressin levels in human septic shock is depletion of the secretory stores of the neurohypophysis. This has been observed with strong osmotic stimuli,27 28 29 and endotoxin is a most potent vasopressin secretagogue.16 In animal models of acute septic shock,14 15 16 an enormous rise in plasma vasopressin during the 1 to 2 hours after endotoxin/bacterial administration (even before hypotension14 ) is followed by a rapid decline over the next few hours; no study has monitored plasma vasopressin in animals with septic shock of more than a few hours' duration.
Needless to say, the mechanisms responsible for the profound vasodilation of septic shock are of great interest. Previous work has demonstrated abnormal activation of vasodilatory mechanisms in experimental models of septic shock.2 3 The findings reported herein document an abnormality of a vasoconstrictor mechanism critical for arterial pressure maintenance and provide the basis for new inquiries into the pathogenesis of the vasodilation in septic shock.
Received October 28, 1996; revision received January 6, 1997; accepted January 15, 1997.
| References |
|---|
|
|
|---|
2.
Kilbourn RG, Gross SS, Jurbran A, Adams J, Griffith OW, Levi R, Lodatao RF. NG-methyl-L-arginine inhibits tumor necrosis factor-induced hypotension: implications for the involvement of nitric oxide. Proc Natl Acad Sci U S A.. 1990;87:3629-3632.
3. Landry DW, Oliver JA. The ATP-sensitive K+ channel mediates hypotension in endotoxemia and hypoxic lactic acidosis in dog. J Clin Invest.. 1992;89:2071-2074.
4. Meadows D, Edwards JD, Wilkins RG, Nightingale P. Reversal of intractable septic shock with norepinephrine therapy. Crit Care Med. 1988;16:663-666.[Medline] [Order article via Infotrieve]
5. Chernow B, Roth BL. Pharmacologic manipulation of the peripheral vasculature in shock: clinical and experimental approaches. Circ Shock.. 1986;18:141-155.[Medline] [Order article via Infotrieve]
6. Baker CH, Sutton ET, Dietz JR. Endotoxic alteration of muscle microvascular renin-angiotensin responses. Circ Shock.. 1991;36:224-230.
7. Weitzberg E, Lundberg JM, Rudehill A. Elevated plasma levels of endothelin in patients with sepsis syndrome. Circ Shock.. 1991;33:222-227.[Medline] [Order article via Infotrieve]
8.
Grollman A, Geiling EMK. The cardiovascular and metabolic reactions of man to the intramuscular injection of posterior pituitary liquid (Pituitrin), Pitressin and Pitocin. J Pharmacol Exp Ther.. 1932;46:447-460.
9. Graybiel A, Glendy RE. Circulatory effects following the intravenous administration of Pitressin in normal persons and in patients with hypertension and angina pectoris. Am Heart J.. 1941;21:481-489.
10. Wagner HN Jr, Braunwald E. The pressor effect of the antidiuretic principle of the posterior pituitary in orthostatic hypotension. J Clin Invest.. 1956;35:1412-1418.
11. Aisenbrey GA, Handelman WA, Arnold P, Manning M, Schrier RW. Vascular effects of arginine vasopressin during fluid deprivation in the rat. J Clin Invest.. 1981;67:961-968.
12. Schwartz J, Reid IA. Effect of vasopressin blockade on blood pressure regulation during hemorrhage in conscious dogs. Endocrinology.. 1981;108:1778-1780.
13.
Schwartz J, Keil LC, Maselli J, Reid IA. Role of vasopressin in blood pressure regulation during adrenal insufficiency. Endocrinology.. 1983;112:234-238.
14. Wilson MF, Brackett DJ, Hinshaw LB, Tompkins P, Archer LT, Benjamin BA. Vasopressin release during sepsis and septic shock in baboons and dogs. Surg Gynecol Obstet.. 1981;153:869-872.[Medline] [Order article via Infotrieve]
15. Wilson MF, Brackett DJ, Tompkins P, Benjamin B, Archer LT, Hinshaw LB. Elevated plasma vasopressin concentrations during endotoxin and E. coli shock. Adv Shock Res.. 1981;6:15-26.[Medline] [Order article via Infotrieve]
16. Brackett DJ, Schaefer CF, Tompkins P, Fagraeus L, Peters LJ, Wilson MF. Evaluation of cardiac output, total peripheral vascular resistance, and plasma concentrations of vasopressin in the conscious, unrestrained rat during endotoxemia. Circ Shock.. 1985;17:273-284.[Medline] [Order article via Infotrieve]
17.
Bone RC, Balk RA, Cerra FB, Delling RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest.. 1992;101:1644-1653.
18.
Califf RM, Bengtson JR. Cardiogenic shock. N Engl J Med.. 1994;330:1724-1730.
19. Sakurai K. A simple and highly sensitive radioimmunoassay for 8-arginine vasopressin in human plasma using a reversed-phase C18 silica column. Folia Endocrinol.. 1985;61:724-736.
20. Minaker KL, Meneilly GS, Young JB, Landsberg L, Stoff JS, Robertson GL, Rowe JW. Blood pressure, pulse and neurohumoral responses to nitroprusside-induced hypotension in normotensive aging men. J Gerontol Med Sci.. 1991;46:M151-M154.
21. Robertson GL. The regulation of vasopressin function in health and disease. Recent Prog Horm Res.. 1977;33:333-386.
22. Mohring J, Glanzer K, Maciel JA Jr, Dusing R, Kramer HJ, Arbogast R, Koch-Weser J. Greatly enhanced pressor response to antidiuretic hormone in patients with impaired cardiovascular reflexes due to idiopathic orthostatic hypotension. J Cardiovasc Pharmacol.. 1980;2:367-376.[Medline] [Order article via Infotrieve]
23. Zerbe RL, Henry DP, Robertson GL. Vasopressin response to orthostatic hypotension: etiologic and clinical implications. Am J Med.. 1983;74:265-271.[Medline] [Order article via Infotrieve]
24. Kaufmann H, Oribe E, Oliver JA. Plasma endothelin during upright tilt: relevance for orthostatic hypotension? Lancet.. 1991;338:1542-1545.[Medline] [Order article via Infotrieve]
25. Garrard CS, Kontoyannis DA, Piepoli M. Spectral analysis of heart rate variability in the sepsis syndrome. Clin Auton Res.. 1993;3:5-13.[Medline] [Order article via Infotrieve]
26.
Cowley AW Jr, Monos E, Guyton AC. Interaction of vasopressin and the baroreceptor reflex system in the regulation of arterial blood pressure in the dog. Circ Res.. 1974;34:505-514.
27. Cooke CR, Wall BM, Jones GV, Presley DN, Share L. Reversible vasopressin deficiency in severe hypernatremia. Am J Kidney Dis.. 1993;22:44-52.[Medline] [Order article via Infotrieve]
28. Negro-Vilar A, Samson WK. Dehydration-induced changes in immunoreactive vasopressin levels in specific hypothalamic structures. Brain Res.. 1979;169:585-589.[Medline] [Order article via Infotrieve]
29.
Jones CW, Pickering BT. Comparison of the effects of water deprivation and sodium chloride inhibition on the hormone content of the neurohypophysis of the rat. J. Physiol.. 1969;203:449-458.
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P. T. Murray, M. E. Wylam, and J. G. Umans Nitric Oxide and Septic Vascular Dysfunction Anesth. Analg., January 1, 2000; 90(1): 89 - 89. [Full Text] [PDF] |
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S. M. Brabant, M. Bertrand, D. Eyraud, P.-L. Darmon, and P. Coriat The Hemodynamic Effects of Anesthetic Induction in Vascular Surgical Patients Chronically Treated with Angiotensin II Receptor Antagonists Anesth. Analg., December 1, 1999; 89(6): 1388 - 1388. [Abstract] [Full Text] [PDF] |
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E. B. Rosenzweig, T. J. Starc, J. M. Chen, S. Cullinane, D. M. Timchak, W. M. Gersony, D. W. Landry, and M. E. Galantowicz Intravenous Arginine-Vasopressin in Children With Vasodilatory Shock After Cardiac Surgery Circulation, November 9, 1999; 100 (2009): II-182 - II-186. [Abstract] [Full Text] [PDF] |
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S. M. Brabant, D. Eyraud, M. Bertrand, and P. Coriat Refractory Hypotension After Induction of Anesthesia in a Patient Chronically Treated with Angiotensin Receptor Antagonists Anesth. Analg., October 1, 1999; 89(4): 887 - 887. [Full Text] [PDF] |
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D. Morales, J. Madigan, S. Cullinane, J. Chen, M. Heath, M. Oz, J. A. Oliver, and D. W. Landry Reversal by Vasopressin of Intractable Hypotension in the Late Phase of Hemorrhagic Shock Circulation, July 20, 1999; 100(3): 226 - 229. [Abstract] [Full Text] [PDF] |
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Y. Hamu, Y. Kanmura, I. Tsuneyoshi, and N. Yoshimura The Effects of Vasopressin on Endotoxin-Induced Attenuation of Contractile Responses in Human Gastroepiploic Arteries In Vitro Anesth. Analg., March 1, 1999; 88(3): 542 - 542. [Abstract] [Full Text] [PDF] |
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K.-L. Laugwitz, M. Ungerer, T. Schoneberg, H.-J. Weig, K. Kronsbein, A. Moretti, K. Hoffmann, M. Seyfarth, G. Schultz, and A. Schomig Adenoviral Gene Transfer of the Human V2 Vasopressin Receptor Improves Contractile Force of Rat Cardiomyocytes Circulation, February 23, 1999; 99(7): 925 - 933. [Abstract] [Full Text] [PDF] |
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J. A. M. Avontuur, F. Boomsma, A. H. van den Meiracker, F. H. de Jong, and H. A. Bruining Endothelin-1 and Blood Pressure After Inhibition of Nitric Oxide Synthesis in Human Septic Shock Circulation, January 19, 1999; 99(2): 271 - 275. [Abstract] [Full Text] [PDF] |
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S. E. Buijk, H. A. Bruining, J. A. Oliver, and D. W. Landry Vasopressin Deficiency Contributes to the Vasodilation of Septic Shock • Response Circulation, July 14, 1998; 98(2): 187 - 187. [Full Text] [PDF] |
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Vasopressin and Septic Shock Journal Watch Cardiology, April 28, 1997; 1997(428): 14 - 14. [Full Text] |
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I. A. Reid Role of Vasopressin Deficiency in the Vasodilation of Septic Shock Circulation, March 4, 1997; 95(5): 1108 - 1110. [Full Text] |
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M. Bucher, J. Hobbhahn, K. Taeger, and A. Kurtz Cytokine-mediated downregulation of vasopressin V1A receptors during acute endotoxemia in rats Am J Physiol Regulatory Integrative Comp Physiol, April 1, 2002; 282(4): R979 - R984. [Abstract] [Full Text] [PDF] |
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K.-L. Laugwitz, H.-J. Weig, A. Moretti, E. Hoffmann, P. Ueblacker, I. Pragst, K. Rosport, A. Schomig, and M. Ungerer Gene Transfer of Heterologous G Protein-Coupled Receptors to Cardiomyocytes : Differential Effects on Contractility Circ. Res., April 13, 2001; 88(7): 688 - 695. [Abstract] [Full Text] [PDF] |
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