Use of vasopressin in the treatment of refractory septic shock

ABSTRACT Objective: To evaluate the short-term evolution of patients with septic shock refractory to norepinephrine treated with vasopressin in an intensive care unit of a university hospital. Methods: An unmatched retrospective study (case series) was performed. Clinical, laboratory, and anthropometric data were collected from patients who received vasopressin infusion for treatment of catecholamine-refractory shock from December 2014 to June 2016. For the assessment of severity, APACHE II and SOFA scores were used. The main outcome was mortality at 3 and 30 days. Results: A total of 80 patients were included, of which 60% were male. In 86.3% of the cases, APACHE II was observed in the highest ranges (> 20). The 30-day mortality was 86.2%, and 75% of the patients died within 72 hours after starting vasopressin. Conclusion: The series evaluated had high mortality in the first 72 hours of treatment with vasopressin. The use of vasopressin in patients who are refractory to norepinephrine had little or no impact on mortality. It was not possible to exclude the possibility that the high mortality in the present study was linked to the relatively late onset (after established refractoriness of norepinephrine) of vasopressin; this hypothesis should be further evaluated in a randomized study.

摘要
目的：评估某大学附属医院重症监护病房内，接受血管加压素治疗去甲肾上腺素难治性感染性休克患者的短期转归。
方法：本研究为非匹配设计的回顾性病例系列研究。纳入2014年12月至2016年6月期间，因儿茶酚胺难治性休克接受血管加压素输注治疗的患者，收集其临床资料、实验室检测结果及人体测量学数据；采用急性生理学与慢性健康状况评分系统II（APACHE II）与序贯器官衰竭评分（SOFA）进行病情严重程度评估；主要结局指标为3天及30天死亡率。
结果：共纳入80例患者，其中男性占60%。86.3%的患者APACHE II评分处于最高区间（＞20分）。30天死亡率为86.2%，75%的患者在开始接受血管加压素治疗后72小时内死亡。
结论：本病例系列研究显示，接受血管加压素治疗的患者在治疗最初72小时内死亡率较高。对于去甲肾上腺素难治性休克患者，血管加压素的使用对死亡率几乎无改善或无显著影响。本研究无法排除本次研究中高死亡率与血管加压素使用时机相对较晚（即在确认去甲肾上腺素难治性休克后才启动给药）相关的可能性，该假说需通过随机对照研究进一步验证。