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Hemodynamic response to administration of vasopressors among patients with septic shock

Sneha Jyothi A N, Sushma Muraraiah, Vijaya Kumar.

Background: Septic shock is characterized by refractory hypotension with a mortality of >50%. Early fluid resuscitation, if failed, vasopressors are recommended to maintain mean arterial pressure (MAP) of 65 mmHg to restore organ perfusion. Noradrenaline (NA) is the vasopressor of choice but can be associated with adrenergic hyposensitivity and adverse effects on prolonged high-dose treatment. Hence, the addition of arginine vasopressin (AVP) to reduce the dose of NA is recommended. In view of the paucity of data in our setup, the present observational study was undertaken.

Aims and Objectives: The present study was conducted to analyze the hemodynamic response to vasopressors among patients in septic shock and to compare the same among patients receiving NA alone or NA + AVP.

Materials and Methods: All consenting adult patients >18 years with septic shock receiving vasopressors were included in the study. Hemodynamic variables such as systolic and diastolic blood pressure and MAP were noted at baseline, 30 min, 1, 6, 24, and 48 h and the same was compared between patients receiving either NA alone or NA + AVP.

Results: The median age was 45 years with male preponderance. At admission, median MAP was 63 mmHg. On administration of vasopressors, target MAP was achieved by 1-h and maintained in both the groups of patients receiving NA or NA + AVP. No significant differences were noted in terms of hemodynamic parameters among patients receiving NA alone or NA + AVP.

Conclusion: As per the surviving sepsis guidelines 2018, vasopressor administration was initiated and the target MAP of >65 mmHg was achieved by 1 h, sustained over 48 h. No significant differences were noted among the patients receiving NA alone or NA + AVP in terms of hemodynamic variables.

Key words: Septic Shock; Mean Arterial Pressure; Noradrenaline; Arginine Vasopressin

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