VASOPRESSIN/NOREPINEPHRINE COMBINATION FOR HEMODYNAMIC STABILIZATION OF SEPTIC PATIENTS

Background: The use of vasopressors as a main line of combating septic shock is something which is agreed upon, but what agent to use, whether to add another agent or not and when to add this one are still points of controversy. Norepinephrine and vasopressin are the most widely included separately in ICU protocols, but the idea of using a combination is still a new one. Methods: 60 patients admitted to ICU with severe sepsis or septic shock was enrolled in a randomized trial. They all fulfilled the approved criteria for sepsis. All patients received standardized supportive careincluding volume infusion, supplemental O2, antibiotics, nutrition, GIT prophylaxis, and control of the source of infection. Patients were randomly allocated into two equal groups (n=30). Group I Patients received standard treatment of sepsis plus norepinephrine fixed volume infusion of 8 fig/min for 24 hrs, while Group II Patients received standard treatment of sepsis plus norepinephrine infusion (8 fg/min for 24 hrs as before) combined with vasopressin fixed volume infusion of 0.04 units/min for24 hrs. Data monitored during the first 24 hours of vasopressor infusion were: Cerebral blood flow by measuring cerebral arterio-venous oxygen content difference (AVDO2) just before and 24 hours after starting infusion, heart rate, invasive MAP, CVP before and every 6 hours for the next 24 hours (T0-T4). Laboratory monitoring included kidney function tests (blood urea and creatinine), liver function test (Bilirubin (total direct), AST, ALT), and CBC just before and 24 hours after starting infusion. Results: In Group II heart rate had decreased significantly compared to baseline starting from T1-T4 (p 0.002 for T1, T2, T3 T4). Heart rates in group I were comparable to those in group II during T1 and T2, but were higher during T3 and T4 (P=0.016 0.01). MAP values were significantly higher compared to baseline among both groups (Table 2), but were significantly lower in Group I compared to Group II. The differences between both groups regarding cerebral AVDO2, CVP and respiratory parameters were statistically insignificant. Also, no statistically significantdifferences were found between both groups regarding laboratory parameters, ICU stay and hospital stay. Conclusion: we were only able to demonstrate a significant benefit of adding vasopressin to nor-epinephrine on mean arterial blood pressure, which apparently did not affect survival rate or hospital stay.