Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 26 , ISSUE 6 ( June, 2022 ) > List of Articles

Original Article

Comparison of Norepinephrine and Terlipressin vs Norepinephrine Alone for Management of Septic Shock: A Randomized Control Study

Pradeep K Bhatia

Keywords : Norepinephrine, Septic shock, Terlipressin

Citation Information : Bhatia PK. Comparison of Norepinephrine and Terlipressin vs Norepinephrine Alone for Management of Septic Shock: A Randomized Control Study. Indian J Crit Care Med 2022; 26 (6):669-675.

DOI: 10.5005/jp-journals-10071-24231

License: CC BY-NC 4.0

Published Online: 20-06-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Purpose: To compare norepinephrine and terlipressin vs norepinephrine alone for management of septic shock. Materials and methods: In this prospective, randomized control trial, 50 adult patients with septic shock were randomized into two groups. Group I received a combination of injection terlipressin 0.02 µg/kg/min (fixed dose) infusion and injection norepinephrine 0.01 µg/kg/min infusion and group II received injection norepinephrine 0.01 µg/kg/min infusion alone. Dose of noradrenaline in both the groups was titrated to achieve the target MAP of 65–70 mm Hg. The data collected were the dose of norepinephrine required to maintain an MAP of above 65 mm Hg, urine output, serum lactate, procalcitonin level, C-reactive protein, sequential organ failure assessment (SOFA) score, total duration of vasopressor support, and incidences of the adverse effects. Results: The norepinephrine dose in group I vs group II at 12 hours was found to be 0.141 ± 0.067 vs 0.374 ± 0.096 µg/kg/min (p ≤0.005). The serum lactate was lower, and urine output was higher in group I than group II (p <0.05). Group I had a significantly greater reduction in SOFA score in 12 hours than group II. Group I patient also had a significant decrease in the duration of vasopressor administration than group II patients being discharged from the ICU. However, there was no difference in the mortality between the two groups during their ICU stay. Conclusion: A low-dose continuous infusion of terlipressin and norepinephrine could help attain early resuscitation goals for managing patients with septic shock.


HTML PDF Share
  1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:801–810. DOI: 10.1001/jama.2016.0287.
  2. Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med 2018;44:925–928. DOI: 10.1007/s00134-018-5085-0.
  3. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017;43:304–377. DOI: 10.1007/s00134-017-4683-6.
  4. Müllner M, Urbanek B, Havel C, Losert H, Waechter F, Gamper G. Vasopressors for shock. Cochrane Database Syst Rev 2004;3:CD003709. DOI: 10.1002/14651858.CD003709.
  5. Schmittinger CA, Torgersen C, Luckner G, Schröder DCH, Lorenz I, Dünser MW. Adverse cardiac events during catecholamine vasopressor therapy: a prospective observational study. Intensive Care Med 2012;38:950–958. DOI: 10.1007/s00134-012-2531-2.
  6. Anantasit N, Boyd JH, Walley KR, Russell JA. Serious adverse events associated with vasopressin and norepinephrine infusion in septic shock. Crit Care Med 2014;42:1812–1820. DOI: 10.1097/CCM.0000000000000333.
  7. Martin C, Medam S, Antonini F, Alingrin J, Haddam M, Hammad E, et al. Norepinephrine: not too much, too long. Shock 2015;44:305–309. DOI: 10.1097/SHK.0000000000000426.
  8. Svoboda P, Scheer P, Kantorová I, Doubek J, Dudra J, Radvan M, et al. Terlipressin in the treatment of late phase catecholamine-resistant septic shock. Hepatogastroenterology 2012;59:1043–1047. DOI: 10.5754/hge10550.
  9. Leone M, Boyle WA. Decreased vasopressin responsiveness in vasodilatory septic shock-like conditions. Crit Care Med 2006;34: 1126–1130. DOI: 10.1097/01.CCM.0000206466.56669.BE.
  10. Demiselle J, Fage N, Radermacher P, Asfar P. Vasopressin and its analogues in shock states a review. Ann Intensive Care 2020;10:9. DOI: 10.1186/s13613-020-0628-2.
  11. Barzegar E, Nouri M, Mousavi S, Ahmadi A, Mojtahedzadeh M. Vasopressin in septic shock; assessment of sepsis biomarkers: a randomized, controlled trial. Indian J Crit Care Med 2017;21:578–584. DOI: 10.4103/ijccm.IJCCM_258_17.
  12. Ohsugi K, Kotani T, Fukuda S, Sato Y, Toyama S, Ozaki M. Does vasopressin improve the mortality of septic shock patients treated with high-dose NA. Indian J Crit Care Med 2016;20:137–140. DOI: 10.4103/0972-5229.178175.
  13. Russell JA, Walley KR, Singer J, VASST Investigators, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 2008;358:877–887. DOI: 10.1056/NEJMoa067373.
  14. Torgersen C, Dünser MW, Wenzel V, Wenzel V, Jochberger S, Mayr V, et al. Comparing two different arginine vasopressin doses in advanced vasodilatory shock: a randomized, controlled, open-label trial. Intensive Care Med 2010;36:57–65. DOI: 10.1007/s00134-009-1630-1631.
  15. Salazar M, Hu BB, Vazquez J, Wintz RL, Varon J. Exogenous vasopressin-induced hyponatremia in patients with vasodilatory shock: two case reports and literature review. J Intensive Care Med 2015;30:253–258. DOI: 10.1177/0885066613507410.
  16. Bernadich C, Bandi JC, Melin P, Bosch J. Effects of F-180, a new selective vasoconstrictor peptide, compared with Terlipressin and vasopressin on systemic and splanchnic hemodynamics in a rat model of portal hypertension. Hepatology 1998;27:351–356. DOI: 10.1002/hep.510270206.
  17. O'Brien A, Clapp L, Singer M. Terlipressin for norepinephrine-resistant septic shock. Lancet 2002;359:1209–1210. DOI: 10.1016/S0140-6736(02)08225-9.
  18. Morelli A, Ertmer C, Rehberg S, Lange M, Orecchioni A, Cecchini V, et al. Continuous Terlipressin versus vasopressin infusion in septic shock (TERLIVAP): a randomised, controlled pilot study. Crit Care 2009;13:R130. DOI: 10.1186/cc7990.
  19. Gordon AC, Mason AJ, Thirunavukkarasu N, Perkins GD, Cecconi M, Cepkova M, et al. Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock: the VANISH randomized clinical trial. JAMA 2016;316:509–518. DOI: 10.1001/jama.2016.10485.
  20. Edwards RM, Trizna W, Kinter LB. Renal microvascular effects of vasopressin and vasopressin antagonists. Am J Physiol 1989;256: F274–F278. DOI: 10.1152/ajprenal.1989.256.2.F274.
  21. den Ouden DT, Meinders AE. Vasopressin: physiology and clinical use in patients with vasodilatory shock: a review. Neth J Med 2005;63(1):4–13. PMID: 15719846.
  22. Holmes CL, Patel BM, Russell JA, Walley KR. Physiology of vasopressin relevant to the management of septic shock. Chest 2001;120: 989–1002. DOI: 10.1378/chest.120.3.989.
  23. Liu ZM, Chen J, Kou Q, Lin Q, Huang X, Tang Z, et al. Terlipressin versus Norepinephrine as an infusion in patients with septic shock: a multicentre, randomised, double-blinded trial. Intensive Care Med 2018;44:1816–1825. DOI: 10.1007/s00134-018-5267-9.
  24. Albanèse J, Leone M, Delmas A, Martin C. Terlipressin or norepinephrine in hyperdynamic septic shock: a prospective, randomised study. Crit Care Med 2005;33:1897–1902. DOI: 10.1097/01.ccm.0000178182.37639.d6.
  25. Xiao X, Zhang J, Wang Y, Zhou J, Zhu Y, Jiang D, et al. Effects of Terlipressin on patients with sepsis via improving tissue blood flow. J Surg Res 2016;200:274–282. DOI: 10.1016/j.jss.2015.07.016.
  26. Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med 1998;26:1793–1800. DOI: 10.1097/00003246-199811000- 00016.
  27. Levy MM, Macias WL, Vincent JL, Russell JA, Silva E, Trzaskoma B, et al. Early changes in organ function predict eventual survival in severe sepsis. Crit Care Med 2005;33:2194–2201. DOI: 10.1097/01.ccm.0000182798.39709.84.
  28. Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286:1754–1758. DOI: 10.1001/jama.286.14.1754.
  29. Xiao X, Zhu Y, Zhen D, Chen XM, Yue W, Liu L, et al. Beneficial and side effects of arginine vasopressin and Terlipressin for septic shock. J Surg Res 2015;195:568–579. DOI: 10.1016/j.jss.2015.02.022.
  30. Leone M, Albanèse J, Delmas A, Chaabane W, Garnier F, Martin C. Terlipressin in catecholamine-resistant septic shock patients. Shock 2004;22:314–319. DOI: 10.1097/01.shk.0000136097.42048.bd.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.