Effects of terlipressin on systemic and regional haemodynamics in catecholamine-treated hyperkinetic septic shock

Objectives: To determine the effects of an intravenous bolus dose of a vasopressin analogue, terlipressin (1 mg), on systemic haemodynamic parameters and gastric mucosal perfusion (GMP) in patients with catecholamine-treated septic shock using a gastric tonometry and laser-Doppler flowmetry technique. Design: Prospective open label study. Settings: Two multidisciplinary intensive care units. Patients: Fifteen patients with norepinephrine-treated septic shock. Interventions: Every patient with mean arterial pressure between 50 and 55 mmHg treated with high dose norepinephrine received an intravenous bolus dose of terlipressin as last resort therapy. A laser-Doppler probe and tonometer were introduced into the gastric lumen. Measurements and main results: Terlipressin produced a decrease in cardiac output (p<0.05), a progressive increase in mean arterial pressure (p<0.05) and in GMP, detected by laser-Doppler flowmetry (p<0.05) over 30 min and sustained for at least 24 h. The ratio of GMP to systemic oxygen delivery increased after terlipressin bolus dose (p<0.05). The gradient between gastric mucosal and arterial PCO tended to be lower after terlipressin, and the difference was statistically significant (p<0.05) after 8 h. Terlipressin administration significantly increased (p<0.05) urine output compared to baseline and higher values were found at each set of measurement. The terlipressin-induced increase in urine output was associated with a significantly increased creatinine clearance (p<0.05). Reduction of the high-dose norepinephrine was observed in all patients (p<0.05). Conclusions: Our findings showed that, in patients with norepinephrine-treated septic shock, terlipressin increased GMP, urine output and creatinine clearance by an increase in mean arterial pressure. © Springer-Verlag 2003.