Abstract
Vasopressin (VP) is effective in restoring mean arterial pressure (MAP) in catecholamine‐resistant shock and seems to augment adrenergic vasopressor action. We thus examined whether VP may influence adrenal function early on in hemorrhage. Using a pig model of severe rapid hemorrhage (30 ml/kg blood loss in 20 minutes), we compared the effect of fluid resuscitation (NS; normal saline equal to no more than 2 times the shed volume, n=9) in combination with VP (30 ng/kg/min, n=7), phenylephrine (PE; 5 mg/kg/min, n=6), or norepinephrine (NE; 0.1 mg/kg/min, n=7) against fluid resuscitation alone. Hemorrhage caused a 50% drop in MAP (74±2 to 36±1 mm Hg, p<0.05) and decreased cardiac output (CO; from 3.5±0.1 to 2.0±0.1 L/min, p<0.05). VP returned MAP to baseline (72±4 mm Hg), versus partial restoration with the other treatments (50±6, 53±4, and 53±3 mm Hg, for NS, PE, and NE, respectively). CO was restored with fluid resuscitation in all groups. Interestingly, adrenal blood flow doubled with the endogenous response to hemorrhage. VP administration further increased adrenal blood flow to 3.6 + 0.9 times baseline. PE, NE or NS did not exhibit this enhanced augmentation. Cortisol, aldosterone, adrenocorticotropic hormone, epinephrine and norepinephrine levels all increased in response to hemorrhage and returned to baseline with correction of blood pressure. There was no evidence of adrenal insufficiency in this acute phase of shock. VP‐induced increase in adrenal blood flow during hemorrhage may help prevent development of adrenal insufficiency as a long term complication of severe hemorrhagic shock.
Published Version
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