Vasopressin for Septic Shock

Nitecap · Jun 17, 2004

We use a ton of vaso drips in the CTICU that I work in. Different MD's have their preference. Some use norepi, some vaso. Pt's do very well with the vaso. .9 u/kg/min is the max we usually titrate to, some dont like to go that high even because have big risk for meseneric ischemia d/t profound vasoconstriction.

MelRN13 · Jun 17, 2004

We have also been using it recently for sepsis at a rate of 0.04 units/minute. It has worked well in cases of true sepsis.

Pediatric Critical Care Columnist · Jun 18, 2004

Here are three good articles from Medscape on the use of vasopressin in septic shock. We use it as a last resort in our unit, usually at .03 microunits/kg/min. for our peds patients. It has saved our bacon more than once. I've also used activated protein C in severe sepsis with excellent results.

http://www.medscape.com/viewarticle/462394?src=search

http://www.medscape.com/viewarticle/451242?src=search

http://www.medscape.com/viewarticle/452370?src=search

critcarenurse16 · Jun 21, 2004

Is anyone using Xigris (sp) for septic shock yet?? I've heard it has great outcomes for septic shock syndrome but have not used it yet. Just wondering what your opinions are.:)

Pediatric Critical Care Columnist · Jun 21, 2004

Xigris is the patent name for drotecogin alfa, which is another name for activated protein C. We used it very successfully in Winnipeg about three years ago in a teenager with meningoccemia. She was admitted with fulminant disease and recovered enough to leave PICU within four days. Her sequelae were limited to a couple of small patches of necrotic skin on her leg. Only fourteen months earlier we had treated a toddler who required amputation of both feet, several fingers and multiple skin grafts. So I wouldn't hesitate to use Xigris again.

CRNAStudent · Jun 30, 2004

In the CTICU I worked in, we used vaso frequently. Usually it was in addition to levo, after we had reached at least 10mcg/min. We typically started the vaso at 2units/hour (100U/100cc). It is actually kind of amazing to see - some patients just need a touch of vaso, and you can wean the levo off in a matter of hours. Our intensivists have started trying something new, and it actually seems to work in some patients. After the pt is off levo and other pressors except vaso, they will start SQ vasopressin. I know it sounds nuts - but I saw a couple of patients who started the SQ regimen and the next day were off IV vaso. Coincidence, maybe...who knows - maybe a new treatment modality for weaning it. The dose was typically 6units SQ Q6 or Q8hours. Anyone else ever do this?

Pediatric Critical Care Columnist · Jun 30, 2004

Our unit is now participating in a study "Vasopressin in Pediatric Shock" or VIPS for short. I'm not sure of the details but it's a multicenter trial. I'll find out more and post it here.

nursewratchet · Sep 6, 2004

For those of you using vasopressin for septic shock, how fast are you tapering off? I know depends on BP, but if they are tolerating, how quickly have you gone? From what I've read, I understand it has a fairly short half life so to me seems you can go pretty quickly.

apontius · Sep 8, 2004

I have used Vasopressin as a last ditch effort for septic shock. Our docs are leaming more toward Xigris. Seems to work wonders if sepsis is detected early enough. By the way, the vasopressin didn't work either.

Stlcardsrock · Sep 8, 2004

I have used Vasopressin as a last ditch effort for septic shock. Our docs are leaming more toward Xigris. Seems to work wonders if sepsis is detected early enough. By the way, the vasopressin didn't work either.

I don't understand your post.

Vasopressin should not be a last ditch effort.

Xigris and Vasopressin cannot be compared,

they are two completely different drugs.

In septic shock, they should be used in conjunction.

Xigris needs to be started early in the cascade, if it is, it will work wonders.

Vasopressin should be started as early as possible to keep SBP near 100.

This will provide adequate perfusion for all organs.

I know most will say SBP at 90, but the physicians here prefer that.

They also need ridiculously high filling volumes.

Your last dich effort should be Neosynephrine.

apontius · Sep 9, 2004

While I appreciate the difference between Vaso and Xigris, my point to be made was that our findings are that if Xigris is initiated in the earliest detection of sepsis, it makes the need for pressors a mute point. The docs I work with prefer Neo and Levo to keep a MAP >60. I was not comparing the two in heroic measures.

Trauma1 · Sep 9, 2004

Our hospital standard is vasopressin 25units/250cc normal saline for 100mUnits/cc.
Infusion ranges is 0.01-0.08 Units/minute (6-48cc/hr)
Central line is preferred.
Good article from Anaes. Intensive Cre 29(5): 463-72 "Vasopressin and Shock"

In our hospital we use vasopressin all the time for septic shock. It's great because it has less alpha HR raising effects than dopamine. In cardiogenic shock there is new evidence that the SVR is actually lower than initially thought and the use of vasopressin may be indicated in people with low to normal SVR in cardiogenic shock.