Beneficial effects of short-term vasopressin infusion during severe septic shock

Anesthesiology. 2002 Mar;96(3):576-82. doi: 10.1097/00000542-200203000-00011.


Background: Septic shock is associated with vasopressin deficiency and a hypersensitivity to its exogenous administration. The goal of the current study was to determine whether short-term vasopressin infusion in patients experiencing severe septic shock has a vasopressor sparing effect while maintaining hemodynamic stability and adequate end-organ perfusion.

Methods: Patients experiencing septic shock that required high-dose vasopressor support were randomized to a double-blinded 4-h infusion of either norepinephrine (n = 11) or vasopressin (n = 13), and open-label vasopressors were titrated to maintain blood pressure. To assess end-organ perfusion, urine output and creatinine clearance, gastric mucosal carbon dioxide tension, and electrocardiogram ST segment position were measured.

Results: Patients randomized to norepinephrine went from a median prestudy norepinephrine infusion of 20.0 microg/min to a blinded infusion of 17.0 mug/min at 4 h, whereas those randomized to vasopressin went from a median prestudy norepinephrine infusion of 25.0 microg/min to 5.3 microg/min at 4 h (P < 0.001). Mean arterial pressure and cardiac index were maintained in both groups. Urine output did not change in the norepinephrine group (median, 25 to 15 ml/h) but increased substantially in the vasopressin group (median, 32.5 to 65 ml/h; P < 0.05). Similarly, creatinine clearance did not change in the norepinephrine group but increased by 75% in the vasopressin group (P < 0.05). Gastric mucosal carbon dioxide tension and electrocardiogram ST segments did not change significantly in either group.

Conclusions: The authors conclude that short-term vasopressin infusion spared conventional vasopressor use and improved some measures of renal function in patients with severe septic shock.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Pressure / drug effects
  • Carbon Dioxide / blood
  • Cardiac Output / drug effects
  • Creatinine / urine
  • Double-Blind Method
  • Electrocardiography / drug effects
  • Female
  • Hemodynamics / physiology
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Natriuresis / drug effects
  • Norepinephrine / therapeutic use
  • Regional Blood Flow / physiology
  • Shock, Septic / drug therapy*
  • Shock, Septic / physiopathology
  • Urodynamics / physiology
  • Vascular Resistance / drug effects
  • Vasoconstrictor Agents / therapeutic use
  • Vasopressins / administration & dosage
  • Vasopressins / therapeutic use*


  • Vasoconstrictor Agents
  • Vasopressins
  • Carbon Dioxide
  • Creatinine
  • Norepinephrine