Hämodynamische Beeinflussung des hyperdynamischen septischen Schocks im Großtiermodel - Noradrenalin und ein selektiver V1a-Agonist

Abstract

Introduction: Septic shock is one of the most common diseases on intensive care units. The recent Surviving Sepsis Campaign international guidelines for management of septic shock suggest norepinephrine or dopamine as first line vasopressor and vasopressin as an alternative. Vasopressin is an effective vasoactive drug due to activating the V1a- receptor. Disadvantages of vasopressin like antidiuresis, hypercoagulation and selective vasodilatation are mediated by the V2- receptor. Material and Methods: We tested a new selective V1a- receptor-agonist in hyperdynamic septic shock compared to norepinephrine. A randomized controlled trial on 25 pigs during 24 hours of faecal-peritoneal induced septic shock. Controll-group (NoA) received only norepinephrine as vasopressor. V1a-group received a V1a- selective agonist as vasopressor and if necessary in addition norepinephrine. Results: V1a-group showed a high demand of norepinephrine to maintain mean arterial pressure. NoA-group showed a fall in mean arterial pressure 18 hours after induction of septic shock. Discussion: Due to a heartrate-limitation of 160 beats per minute norepinephrine-dose couldn’t be increased 18 hours after sepsis induction in NoA-group. Thus the pigs of the NoA-group showed a fall in mean arterial pressure. Based on the high demand of norepinephrine in the V1a-group the effectivity of the V1a- receptor agonist is doubtful.