Ten take-home messages on vasopressin use in critically ill patients

Med Intensiva (Engl Ed). 2024 Dec;48(12):704-713. doi: 10.1016/j.medine.2024.09.009. Epub 2024 Oct 22.

Abstract

The most used vasopressors in critically ill patients are exogenous catecholamines, mainly norepinephrine. Their use can be associated with serious adverse events and even increased mortality, especially if administered at high doses. In recent years, the addition of vasopressin has been proposed to counteract the deleterious effects of high doses of catecholamines (decatecholaminization) with the intention of improving the prognosis of these patients. Currently, vasopressin has two main indications: septic shock and vasoplegic shock in the postoperative period of cardiac surgery. In septic shock, current evidence favors its early initiation before reaching high doses of norepinephrine. In the postoperative period of cardiac surgery, the different benefits of the use of vasopressin have been studied, especially in patients with atrial fibrillation and pulmonary hypertension. When used properly, vasopressin is a safe an effective drug for the indications described above.

Keywords: Cardiac surgery; Cirugía cardiaca; Hipotensión; Hypotension; Sepsis; Vasopresina; Vasopresor; Vasopressin; Vasopressor.

Publication types

  • Review

MeSH terms

  • Cardiac Surgical Procedures
  • Critical Illness*
  • Humans
  • Hypertension, Pulmonary / drug therapy
  • Norepinephrine / administration & dosage
  • Norepinephrine / therapeutic use
  • Postoperative Complications / drug therapy
  • Postoperative Complications / prevention & control
  • Shock, Septic* / drug therapy
  • Vasoconstrictor Agents* / administration & dosage
  • Vasoconstrictor Agents* / therapeutic use
  • Vasoplegia / drug therapy
  • Vasoplegia / etiology
  • Vasopressins* / administration & dosage
  • Vasopressins* / therapeutic use

Substances

  • Vasoconstrictor Agents
  • Vasopressins
  • Norepinephrine