Skip to main content
SpringerLink
Log in

Terlipressin in Septic Shock: When and How Much?

  • Conference paper
Intensive Care Medicine

  • 1189 Accesses

Abstract

Septic shock is the prototype of distributive shock characterized by arteriolar and venous vasodilation and pronounced vascular leakage, resulting in tissue edema, low systemic vascular resistance (SVR) and a subsequent fall in mean arterial pressure (MAP) [1]. Multiple mechanisms are involved in the pathogenesis of the vasodilatation noticed in septic shock. Excessive nitric oxide (NO) formation subsequent to upregulation of inducible NO synthase (iNOS) and increased activity of the neuronal NOS isoform (nNOS) represents a major contributor to vasodilation, basically mediated by interaction with the cyclic guanosine monophosphate (cGMP) pathway [1]. In addition, there is increasing evidence that adenosine triphosphate (ATP)-sensitive potassium (K+ ATP) channels are critically involved in the regulation of arterial vascular smooth muscle tone, as well as in the pathophysiology of catecholamine tachyphylaxis in the presence of systemic inflammation and shock states [1, 2]. Further mechanisms include adrenoceptor desensitization and downregulation due to high circulating levels of catecholamines [3, 4]. Last but not least, vasopressin deficiency has been considered as a causative factor in the pathogenesis of vasodilation in septic shock [1, 5].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Landry DW, Oliver JA (2001) The pathogenesis of vasodilatory shock. N Engl J Med 345: 588–595

    Article  PubMed  CAS  Google Scholar 

  2. Lange M, Morelli A, Ertmer C, et al (2007) Role of adenosine triphosphate-sensitive potassium channel inhibition in shock states: Physiology and clinical implications. Shock 28:394–400

    Article  PubMed  CAS  Google Scholar 

  3. Saito T, Takanashi M, Gallagher E, et al (1995) Corticosteroid effect on early beta-adrenergic down-regulation during circulatory shock: hemodynamic study and beta-adrenergic receptor assay. Intensive Care Med 21:204–210

    Article  PubMed  CAS  Google Scholar 

  4. Hotchkiss RS, Karl IE (2003) The pathophysiology and treatment of sepsis. N Engl J Med 348:138–150

    Article  PubMed  CAS  Google Scholar 

  5. Landry DW, Levin HR, Gallant EM, et al (1997) Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation 95:1122–1125

    PubMed  CAS  Google Scholar 

  6. Hollenberg SM, Ahrens TS, Annane D, et al (2004) Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 32:1928–1948

    Article  PubMed  Google Scholar 

  7. Dellinger RP, Carlet JM, Masur H, et al (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32:858–873

    Article  PubMed  Google Scholar 

  8. Holmes CL, Patel BM, Russell JA, Walley KR (2001) Physiology of vasopressin relevant to management of septic shock. Chest 120:989–1002

    Article  PubMed  CAS  Google Scholar 

  9. Westphal M, van Aken H, Ertmer C (2004) Role of vasopressin and terlipressin in the setting of systemic inflammation. In: Vincent JL (ed) Yearbook of Intensive Care and Emergency Medicine. Springer, Hedielber 9, pp 193–205

    Google Scholar 

  10. Holmes CL, Walley KR (2004) Vasopressin in the ICU. Curr Opin Crit Care 10:442–448

    Article  PubMed  Google Scholar 

  11. Cartotto R, McGibney K, Smith T, Abadir A (2007) Vasopressin for the septic burn patient. Burns 33:441–451

    Article  PubMed  Google Scholar 

  12. Barrett LK, Singer M, Clapp LH (2007) Vasopressin: mechanisms of action on the vasculature in health and in septic shock. Crit Care Med 35:33–40

    Article  PubMed  CAS  Google Scholar 

  13. Lee CS (2006) Role of exogenous arginine vasopressin in the management of catecholaminerefractory septic shock. Crit Care Nurse 26:17–23

    PubMed  Google Scholar 

  14. Ertmer C, Bone HG, Westphal M (2006) Arginine vasopressin versus norepinephrine: will the stronger one win the race? Crit Care 10:144

    Article  PubMed  Google Scholar 

  15. Vincent JL (2006) Vasopressin in hypotensive and shock states. Crit Care Clin 22:187–197

    Article  PubMed  CAS  Google Scholar 

  16. Nilsson G, Lindblom P, Ohlin M, Berling R, Vernersson E (1990) Pharmacokinetics of terlipressin after single i.v. doses to healthy volunteers. Drugs Exp Clin Res 16:307–314

    PubMed  CAS  Google Scholar 

  17. Pesaturo AB, Jennings HR, Voils SA (2006) Terlipressin: vasopressin analog and novel drug for septic shock. Ann Pharmacother 40:2170–2177

    Article  PubMed  CAS  Google Scholar 

  18. Forsling ML, Aziz LA, Miller M, Davies R, Donovan B (1980) Conversion of triglycylvasopressin to lysine-vasopressin in man. J Endocrinol 85:237–244

    Article  PubMed  CAS  Google Scholar 

  19. O’Brien A, Clapp L, Singer M (2002) Terlipressin for norepinephrine-resistant septic shock. Lancet 359:1209–1210

    Article  PubMed  CAS  Google Scholar 

  20. Morelli A, Rocco M, Conti G, et al (2004) Effects of terlipressin on systemic and regional haemodynamics in catecholamine-treated hyperkinetic septic shock. Intensive Care Med 30:597–604

    Article  PubMed  Google Scholar 

  21. Albanese J, Leone M, Delmas A, Martin C (2005) Terlipressin or norepinephrine in hyperdynamic septic shock: a prospective, randomized study. Crit Care Med 33:1897–1902

    Article  PubMed  CAS  Google Scholar 

  22. Leone M, Albanese J, Delmas A, Chaabane W, Gamier F, Martin C (2004) Terlipressin in catecholamine-resistant septic shock patients. Shock 22:314–319

    Article  PubMed  CAS  Google Scholar 

  23. Morelli A, Ertmer C, Lange M, Westphal M (2007) Continuous terlipressin infusion in patients with septic shock: less may be best, and the earlier the better? Intensive Care Med 33:1699–1670

    Article  Google Scholar 

  24. Aronsen KF, Bjorkman I, Lindstrom K, Nylander G, Mulder J (1979) The mechanism of lysine-vasopressin hemostasis in bleeding esophageal varices. Acta Chir Scand 145:231–234

    PubMed  CAS  Google Scholar 

  25. Ortega R, Gines P, Uriz J, et al (2002) Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology 36:941–948

    PubMed  CAS  Google Scholar 

  26. Ioannou GN, Doust J, Rockey DC (2003) Systematic review: terlipressin in acute oesophageal variceal haemorrhage. Aliment Pharmacol Ther 17:53–64

    Article  PubMed  CAS  Google Scholar 

  27. Boccara G, Ouattara A, Godet G, et al (2003) Terlipressin versus norepinephrine to correct refractory arterial hypotension after general anesthesia in patients chronically treated with renin-angiotensin system inhibitors. Anesthesiology 98:1338–1344

    Article  PubMed  CAS  Google Scholar 

  28. Scharte M, Meyer J, Van Aken H, Bone HG (2001) Hemodynamic effects of terlipressin (a synthetic analog of vasopressin) in healthy and endotoxemic sheep. Crit Care Med 29: 1756–1760

    Article  PubMed  CAS  Google Scholar 

  29. Westphal M, Stubbe H, Sielenkamper AW, et al (2003) Terlipressin dose response in healthy and endotoxemic sheep: impact on cardiopulmonary performance and global oxygen transport. Intensive Care Med 29:301–308

    PubMed  Google Scholar 

  30. Asfar P, Pierrot M, Veal N, et al (2003) Low-dose terlipressin improves systemic and splanchnic hemodynamics in fluid-challenged endotoxic rats. Crit Care Med 31:215–220

    Article  PubMed  CAS  Google Scholar 

  31. Asfar P, Hauser B, Ivanyi Z, et al (2005) Low-dose terlipressin during long-term hyperdynamic porcine endotoxemia: effects on hepatosplanchnic perfusion, oxygen exchange, and metabolism. Crit Care Med 33:373–380

    Article  PubMed  CAS  Google Scholar 

  32. Zhao L, Brinton RD (2004) Suppression of proinflammatory cytokines interleukin-lbeta and tumor necrosis factor-alpha in astrocytes by a V1 vasopressin receptor agonist: a cAMP response element-binding protein-dependent mechanism. J Neurosci 24:2226–2235

    Article  PubMed  CAS  Google Scholar 

  33. Naylor AM, Cooper KE, Veale WL (1987) Vasopressin and fever: evidence supporting the existence of an endogenous antipyretic system in the brain. Can J Physiol Pharmacol 65:1333–1338

    PubMed  CAS  Google Scholar 

  34. Lange M, Koehler G, Morelli A, et al (2007) Continuous versus bolus infusion of terlipressin in ovine endotoxemia. Shock 2007 28:623–629

    Article  PubMed  CAS  Google Scholar 

  35. Rehberg S, Ertmer C, Lange M, Morelli A, Van Aken H, Westphal M (2007) Effects of vasopressin and terlipressin in ovine septic shock on mesenteric blood flow and survival. Crit Care 11:P19 (abst)

    Article  Google Scholar 

  36. Traber D (2007) Selective V1a receptor agonists in experimental septic shock. Crit Care 11:P51 (abst)

    Article  Google Scholar 

  37. Landry DW, Levin HR, Gallant EM, et al (1997) Vasopressin pressor hypersensitivity in vasodilatory septic shock. Crit Care Med 25:1279–1282

    Article  PubMed  CAS  Google Scholar 

  38. Rodriguez-Nunez A, Fernandez-Sanmartin M, Martinon-Torres F, Gonzalez-Alonso N, Martinon-Sanchez JM (2004) Terlipressin for catecholamine-resistant septic shock in children. Intensive Care Med 30:477–480

    Article  PubMed  Google Scholar 

  39. Rodriguez-Nunez A, Lopez-Herce J, Gil-Anton J, Hernandez A, Rey C (2006) Rescue treatment with terlipressin in children with refractory septic shock: a clinical study. Crit Care 10:R20

    Article  PubMed  Google Scholar 

  40. Zeballos G, Lopez-Herce J, Fernandez C, Brandstrup KB, Rodriguez-Nunez A (2006) Rescue therapy with terlipressin by continuous infusion in a child with catecholamine-resistant septic shock. Resuscitation 68:151–153

    Article  PubMed  Google Scholar 

  41. Westphal M, Ertmer C, Van Aken H, Bone HG (2004) Terlipressin in patients with septic shock: friend or foe? Intensive Care Med 30:992

    Article  PubMed  CAS  Google Scholar 

  42. Morelli A, Ertmer C, Lange M, Broking K, Orecchioni A, Rocco M, Van Aken H, Pietropaoli P, Westphal M (2007) Effects of simultaneously infused terlipressin and dobutamine in septic shock. Crit Care A794

    Google Scholar 

  43. Dunser MW, Mayr AJ, Tur A, et al (2003) Ischemic skin lesions as a complication of continuous vasopressin infusion in catecholamine-resistant vasodilatory shock: incidence and risk factors. Crit Care Med 31:1394–1398

    Article  PubMed  Google Scholar 

  44. Jolley DH, De Keulenaer BL, Potter A, Stephens DP (2003) Terlipressin infusion in catecholamine-resistant shock. Anaesth Intensive Care 31:560–564

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care, University Hospital, Albert-Schweitzer-Str. 33, 48149, Muenster, Germany

    C. Ertmer & M. Westphal

  2. Department of Anesthesiology and Intensive Care, University of Rome “La Sapienza”, Via Barnaba Oriani 2, 00197, Rome, Italy

    A. Morelli

Authors
  1. C. Ertmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Morelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Westphal
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Intensive Care Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium

    Jean-Louis Vincent MD, PhD, FCCM, FCCP (Head) (Head)

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer Science + Business Media Inc.

About this paper

Cite this paper

Ertmer, C., Morelli, A., Westphal, M. (2008). Terlipressin in Septic Shock: When and How Much?. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-77383-4_40

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-77383-4_40

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-77382-7

  • Online ISBN: 978-0-387-77383-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation