Abstract
Supplementary arginine vasopressin infusion in advanced vasodilatory shock may be accompanied by a decrease in cardiac index and systemic oxygen transport capacity in approximately 40% of patients. While a reduction of cardiac output most frequently occurs in patients with hyperdynamic circulation, it is less often observed in patients with low cardiac index. Infusion of inotropes, such as dobutamine, may be an effective strategy to restore systemic blood flow. However, when administering inotropic drugs, systemic blood flow should be increased to adequately meet systemic demands (assessed by central or mixed venous oxygen saturation) without putting an excessive beta-adrenergic stress on the heart. Overcorrection of cardiac index to hyperdynamic values with inotropes places myocardial oxygen supply at significant risk.
Highlights
A potentially deleterious decrease in cardiac index (CI) during arginine vasopressin (AVP) infusion was reported soon after the first results on the use of AVP in septic shock had been published [3]
In a previous issue of Critical Care, Ertmer and colleagues [1] present an experimental study in which they examine the effects of dobutamine when given together with arginine vasopressin (AVP) in endotoxemic sheep
A recent analysis demonstrated a decrease in CI during AVP infusion in 41% of vasodilatory shock patients
Summary
A potentially deleterious decrease in cardiac index (CI) during AVP infusion was reported soon after the first results on the use of AVP in septic shock had been published [3]. In a previous issue of Critical Care, Ertmer and colleagues [1] present an experimental study in which they examine the effects of dobutamine when given together with arginine vasopressin (AVP) in endotoxemic sheep.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
