Short-term effects of terlipressin bolus infusion on sublingual microcirculatory blood flow during septic shock

Andrea Morelli, Abele Donati, Christian Ertmer, Sebastian Rehberg, Alessandra Orecchioni, Alessandro Di Russo, Paolo Pelaia, Paolo Pietropaoli, Martin Westphal
Intensive Care Medicine 2011, 37 (6): 963-9

PURPOSE: Terlipressin bolus infusion may contribute to overshooting increases in systemic vascular resistance with concomitant reductions in systemic blood flow and oxygen delivery. Whether these effects negatively impact on microcirculatory perfusion is still not known. The objective of the present study was, therefore, to elucidate the effects of a single terlipressin bolus dose of 0.5 mg on microcirculatory perfusion in patients with catecholamine-dependent septic shock.

METHODS: This prospective clinical cohort study was performed in a multidisciplinary intensive care unit at a university hospital. We enrolled 20 patients suffering from catecholamine-dependent septic shock. After restoring normovolaemia, norepinephrine (NE) was titrated to maintain mean arterial pressure (MAP) between 65 and 75 mmHg. Thereafter, all patients received a bolus infusion of 0.5 mg terlipressin, and NE was adjusted to maintain MAP between the threshold values. Sublingual microcirculatory blood flow of small vessels was assessed by sidestream dark-field imaging. All measurements, including data from right heart catheterization and NE requirements, were obtained at baseline and 6 h after terlipressin administration.

RESULTS: Terlipressin stabilized haemodynamics and, at the same time, decreased NE requirements (0.42 ± 0.67 vs. 0.74 ± 0.73 μg/kg per minute, p<0.05). Whereas the pH and arterial lactate concentrations remained unchanged, microcirculatory flow index of small vessels had increased at the end of the 6-h study period (2.6 ± 0.6 vs. 2.0 ± 0.5 units, p<0.05).

CONCLUSION: In fluid-resuscitated patients with septic shock (with a MAP between 65 and 75 mmHg), a bolus infusion of 0.5 mg terlipressin was effective in reducing NE requirements without worsening microcirculatory blood flow. Randomized clinical trials are now warranted to verify these preliminary results.

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