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Hemodynamic effects of arginin vasopressin in low doses in early septic shock

Grant number: 10/50096-6
Support type:Regular Research Grants
Duration: May 01, 2010 - December 31, 2012
Field of knowledge:Health Sciences - Medicine
Principal researcher:Flavia Ribeiro Machado
Grantee:Flavia Ribeiro Machado
Home Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil

Abstract

The vasopressor use in septic shock after volume replacement can assure minimal pressure levels which minimizes organ dysfunction. Among physiological vasopressors, endogenous vasopressin presents a biphasic behavior in septic shock, high levels as a response to hypotension followed by low levels. A controlled prospective study is proposed to evaluate the macro and microcirculatory perfusion alterations secondary to low doses of AVP in early septic shock, in the intensive care units of Disciplina de Anestesiologia, Dor e Terapia Intensiva, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo. Thirty patients will be included with the following inclusion criteria: a maximum of 24 hours of septic shock, maximum norephinephrine or adrenaline dose of 0,5 μgrs/Kg/min, 18 years-old or more, pulmonary arterial catheter in place, signature of informed consent. The exclusion criteria will be: acute coronary disease or acute mesenteric ischemia, severe hyponatremia (<130mmol/L), Reynaud phenomena, systemic sclerosis or pregnancy. The volume responsiveness will be evaluated and using delta PP method and thereafter hemodynamic optimization. Basal hemodynamic measurements and direct visualization of sublingual microcirculation with sidestream darkfiel (SDF) will be done. AVP infusion will be started with 0,03U/min and mantained for one hour, with re-evaluation of basal datas. After that, the drug will be interrupted and a new hemodynamic assessment performed, to confirm that the potential alterations were related to AVP use. All the patients will be randomized to continue or not receiving AVP in order to evaluate the impact on resolution or progression of organ disfunctions. (AU)

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