Arginine vasopressin in advanced vasodilatory shock.

Abstract

To the Editor: In the article by Dunser et al1 on vasopressin in patients with vasodilatory shock, the authors reported that vasopressin is a pressor agent as efficient as norepinephrine but causing fewer arrhythmias. However, we feel that the conclusion that the combination of norepinephrine and vasopressin proved superior to the infusion of norepinephrine alone is not supported by the data for at least 3 reasons. First, the vasoconstrictive effects of vasopressin on gastrointestinal perfusion are of concern. In this study, the increase in bilirubin, quite common in patients with shock, was much more pronounced in patients treated with vasopressin. In addition, the Pco2 gap measurements may not reflect a better preservation of gastric perfusion. Indeed, Pco2 gap increased rapidly, and unexpectedly, to its maximal level already after 1 hour in the norepinephrine group, and then remained stable over time, whereas it increased steadily in the vasopressin group so that similar …