[New therapeutic approaches in the treatment of shock: hypertonic hyperoncotic solutions and vasopressin]

The extreme disturbance of hemodynamics in shock leads to a minimized oxygen delivery to several vital organs. If this state is not rapidly lifted, a multi-organ-failure can occur. In addition to the removal of the underlying causes, for example, bleeding or septic focus, measures must be started to stabilize hemodynamics. In most cases shock can be successfully treated with standard therapeutic interventions including the use of crystalloid or colloid solutions as well as the infusion of inotropes or vasopressors. Up to now, there is not enough evidence to show that hypertonic/hyperoncotic solutions are better for treating hypovolemic shock than standard infusions, other than in situations, where only an inadequate equipment is available. Experimental data support the use of vasopressin instead of fluid loading in case of uncontrolled intra-abdominal bleeding. According to these studies vasopressin seems to be associated with an improved hemodynamic stabilization and a significantly lower mortality rate. However, no clinical tests have been done so far to confirm these results. In septic shock the plasma-levels of vasopressin are low. It has been shown that the infusion of vasopressin contributes to stabilization of hemodynamics in septic shock, in lower, as well as in higher concentrations. On the other hand vasopressin worsens splanchnic perfusion. Therefore the routine use of vasopressin in the treatment of sepsis can not be recommended.