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La deficiencia de vasopresina contribuye a la vasodilatación del shock séptico
D W Landry1, H R Levin, E M Gallant
1Department of Medicine, Columbia University, College of Physicians & Surgeons, New York, NY 10032, USA.
Circulation
|March 4, 1997
Resumen
Los pacientes con shock séptico tienen niveles bajos de vasopresina, lo que contribuye a la hipotensión. La administración de vasopresina eleva efectivamente la presión arterial en estos pacientes.
Área de la Ciencia:
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Endocrinología Endocrinología.
- Fisiología Fisiología Fisiología.
Sus antecedentes:
- El shock séptico se caracteriza por la vasodilatación sistémica y la hipotensión.
- Una observación clínica sugirió una posible deficiencia de vasopresina que contribuye a esta vasodilatación.
Objetivo del estudio:
- Para investigar el papel de la deficiencia de vasopresina en la hipotensión del shock séptico.
- Para determinar si la administración de vasopresina puede mejorar la hemodinámica en pacientes con shock séptico.
Principales métodos:
- Mide los niveles plasmáticos de vasopresina en pacientes con shock séptico y shock cardiogénico.
- Se administró vasopresina exógena a pacientes con shock séptico y se monitorearon las respuestas hemodinámicas.
- Se evaluó el efecto de la retirada y re-administración de vasopresina en un subconjunto de pacientes.
Principales resultados:
- Los pacientes con shock séptico tenían niveles plasmáticos de vasopresina significativamente más bajos en comparación con aquellos con shock cardiogénico.
- La administración de vasopresina aumentó la presión arterial y la resistencia vascular sistémica en pacientes con shock séptico.
- La retirada de la vasopresina condujo a la hipotensión, que fue revertida por la administración de vasopresina.
Conclusiones:
- Los niveles inadecuadamente bajos de vasopresina son una característica del shock séptico vasodilatador, probablemente debido a la alteración de la secreción de barorreflejo.
- La deficiencia de vasopresina contribuye a la hipotensión observada en el shock séptico.
- La vasopresina exógena es un agente presor eficaz en el shock séptico.
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