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（vasopressin）治疗的去甲肾上腺素（norepinephrine）难治性脓毒性休克患者的短期转归。方法：本研究为无匹配对照的回顾性病例系列研究。收集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的临床、实验室及人体测量学数据；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）评估病情严重程度；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60%为男性。86.3%的患者APACHE Ⅱ评分处于高区间（＞20）；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的72小时内死亡。结论：本研究纳入的病例系列在接受血管加压素治疗的前72小时内死亡率较高；对于去甲肾上腺素难治性休克患者，使用血管加压素对死亡率几乎无改善或无显著影响。本研究无法排除高死亡率与血管加压素使用时机相对较晚（即在去甲肾上腺素难治性休克明确后才启用）相关的可能性，该假说需通过随机对照研究进一步验证。