Carrillo ER, González SJA

Idioma: Español
Referencias bibliográficas: 54
Paginas: 5-18
Archivo PDF: 115.14 Kb.

RESUMEN

Introducción: El choque refractario con vasodilatación es secundario a sepsis, choque hemorrágico, posterior a bypass cardiopulmonar, intoxicación con milrinona, trasplantes de órganos, quemaduras, posterior a colocación de dispositivo de asistencia ventricular y en el postoperatorio de puente aortocoronario. Se caracteriza por cursar con niveles inapropiadamente bajos de vasopresina (VP) la cual es fundamental para mantener el índice de resistencia vascular sistémica (IRVS) y la presión arterial (PAM).
Pacientes y métodos: Se incluyeron en el estudio trece pacientes con diagnóstico de choque refractario con vasodilatación. En todos se realizó monitoreo hemodinámico y ecocardiografía. Se inició infusión de VP a dosis de 0.04 UI/min por un lapso de 24 a 96 horas. Las mediciones se realizaron previo a la infusión, así como a intervalos de 2, 4, 8, 16, 24 horas.
Resultados: Se observó durante la infusión de VP un incremento significativo del IRVS y de la PAM (p ‹ 0.05) sin que se modificasen ningún otro de los parámetros valorados. El estado de choque revirtió y fue posible suspender la norepinefrina manteniendo la dopamina a dosis dopa.
Conclusión: El empleo de VP en el choque refractario con vasodilatación a dosis bajas y en infusión continua incrementa el IRVS y la presión de perfusión sin modificar otros parámetros hemodinámicos y/o metabólicos.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Errington ML, Rocha M, Silva E Jr. The secretion and clearance of vasopressin during the development of irreversible haemorrhagic shock. Proc Physiol Soc 1971; 23: 43P-45P.

2. Landry DW, Levin HR, Gallant EM et al. Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation 1997; 95: 1122-1125.

3. Wenzel V, Prengel AW, Maier C et al. Vasopressin improves vital organ blood flow after prolonged cardiac arrest with postcountershock pulseless electrical activity in pigs. Crit Care Med 1999; 27: 486-492.

4. Ridell DC, Mallonee R, Philips JA et al. Chromosomal assignment of human sequences encoding arginine vasopressin-neurophysin II and growth hormone releasing factor. Somat Cell Mol Genet 1985; 11: 189-195.

5. Robertson GL. The regulation of vasopressin function in health and disease. Prog Horm Res 1977; 33: 333-385.

6. Physiological pathways regulating the activity of magnocellular neurosecretory cells. Prog Neurobiol 1999; 57: 625-655.

7. Sklar AH, Schrier R. Central nervous system mediators of vasopressin release. Physiol Rev 1983; 63: 1243-1280.

8. Bourque CW, Oliet SH, Richard D. Osmoreceptors, osmoreception and osmoregulation. Front Neuroendocrinol 1994; 15: 231-274.

9. Schrier RW, Berl T, Anderson RJ. Osmotic and nonosmotic control of vasopressin release. Am J Physiol 1979; 236: F321-F332.

10. Robertson GL, Shelton RL, Athar S. The osmoregulation of vasopressin. Kidney Int 1976; 10: 25-37.

11. Thrasher TN. Baroreceptor regulation of vasopressin and renin secretion: low-pressure versus high-pressure receptors. Front Neuroendocrinol 1994; 15: 157-196.

12. Wang BC, Flora-Ginter G, Leadley RJ Jr et al. Ventricular receptors, stimulate vasopressin release during hemorrhage. Am J Physiol 1988; 254: R204-R211.

13. Reid IA. Role of nitric oxide in the regulation of renin and vasopressin secretion. Front Neuroendocrinol 1994; 15: 351-383.

14. Day TA, Randle JC, Renaud LP. Oppsing alpha-and betaadrenergic mechanisms mediate dose-dependent actions of norepinephrine on supraoptic vasopressin neurones in vivo. Brain Res 1985; 358: 171-179.

15. Randle JC, Bourque CW, Renaud LP. Alpha1-adrenergic receptor activation depolarizes rat supraoptic neurosecretory neurons in vitro. Am J Physiol 1986; 251: R569-R574.

16. Kovacs L, Robertson GL. Syndrome of inappropriate antiduresis. Endocrinol Metab Clin North Am 1992; 21: 859-875.

17. Share L, Kimura T, Matsui K et al. Metabolism of vasopressin. Fed Proc 1985; 44: 59-61.

18. Barberis C, Mouillac B, Durroux T. Structural bases of vasopressin/oxytocin receptor function. J Endocrinol 1998; 156: 223-229.

19. Bichet D. Vasopressin receptors in health and disease. Kidney 1996; 49: 1706-1711.

20. Riphagen CL, Pttman QJ. Arginine vasopressin as a central neurotransmitter. Fed Proc 1986; 45: 2318-2322.

21. Czackes JW. Physiologic studies of antidiuretic hormone by its direct measurement in human plasma. J Clin Invest 1964; 43: 1625-1640.

22. Morton JJ, Padfield PL, Forsling ML. A radioimmunoassay for plasma arginine-vasopressin in man and dog: application to physiological and pathological states. J Endocrinol 1975; 65: 411-424.

23. Arnauld E, Czernichow P, Fumoux F et al. The effects of hypotension and hypovolaemia, on the liberation of vasopressin during hemorrhage in the unanaesthetized monkey (Macaca mulatta). Pflugers Arch Eur J Physiol 1977; 371: 193-200.

24. Cowley AW Jr, Switzer SJ, Guinn MM. Evidence and quantification of the vasopressin arterial pressure control system in the dog. Circ Res 1980; 46: 58-67.

25. Brackett DJ, Shcaefer CF, Wilson MF. The role of vasopressin in the maintenance of cardiovascular function during early endotoxin shock. Adv Shock Res 1983; 9: 147-156.

26. Zerbe RL, Henry DP, Robertson GL. Vasopressin response to orthostatic hypotension: etiologic and clinical implications. Am J Med 1983; 74: 265-271.

27. Schwartz J, Reid IA. Role of vasopressin in blood pressure regulation in conscious water-deprived dogs. Am J Physiol 1983; 244: R74-R77.

28. Mohnring J, Glanzer K, Maciel JA Jr et al. Greatly enhanced pressor response to antidiuretic hormone in patients with impaired cardiovascular reflexes due to idiopathic orthostatic hypotension. J Cardiovasc Pharmocol 1980; 2: 367-376.

29. Wilson MF, Brackett DJ, Tompkins P, Benjamin B, Archer LT, Hinshaw LB. Elevated plasma vasopressin concentrations during endotoxin and E. coli shock. Adv Shock Res 1981; 6: 15-26.

30. Baker CH, Sutton ET, Zhou Z, Dietz JR. Microvascular vasopressin effects during endotoxin shock in the rat. Circ Shock 1990; 30: 81-95.

31. Brackett DJ, Schaefer CF, Wilson MF. The role of vasopressin in the maintenance of cardiovascular function during early endotoxin shock. Adv Shock Res 1983; 9: 147-56.

32. Wilson MF, Brackett DJ, Hinshaw LB et al. Vasopressin release during sepsis and septic shock in babonsand dogs. Surg Gynecol Obstet 1981; 153: 869-872.

33. Errington ML, Rocha e Silva M Jr. The secretion and clearance of vasopressin during the development of irreversible hemorrhagic shock. J Physiol (Lond) 1971; 217: 43P-45P.

34. Brackett DJ, Schaefer CF, Tompkins P et al. Evaluation of cardiac output, total peripheral vascular resistance, and plasma concentrations of vasopressin in the conscious, unrestrained rat during endotoxemia. Circ Shock 1985; 17: 273-284.

35. Landry DW, Levin HR, Gallant EM et al. Vasopressin pressor hypersensitivity in vasodilatory septic shock. Crit Care Med 1997; 25: 1279-1282.

36. Argenziano M, Choudhri AF, Oz MC et al. Prospective randomized trial of arginine vasopressin in the treatment of vasodilatory shock after left ventricular assist device placement. Circulation 1997; 96: II-286-290.

37. Argenziano M, Chen JM, Choudhri AF et al. Management of vasodilatory shock after cardiac surgery: identification of predisposing factors and use of a novel pressor agent. Thorac Cardiovasc Surg 1998; 116: 973-980.

38. Voelckel WG, Lindner K, Wenzel V et al. Effects of vasopressin and epinephrine on splanchnic: blood flow and renal function during and after cardiopulmonary resuscitation in pigs. Crit Care Med 2000: 28.

39. Lindner KH, Prengel AW, Pfenninger EG et al. Vasopressin improves vital organ blood flow during closed-chest CPR in pigs. Circulation 1995; 91: 215-221.

40. Prengel AW, Lindner KH, Keller A. Cerebral oxygenation during cardiopulmonary resuscitation with epinephrine and vasopressin in pigs. Stroke 1996; 27: 1241-1248.

41. Lindner KH, Prengel AW, Brinkmann A et al. Vasopressin administration in refractory cardiac arrest. Ann Intern Med 1996; 124: 1061-1064.

42. Cain BS, Cain JS. Vasopressin in advanced cardiac life support? Crit Care Med 2001: 29.

43. Morris DC, Grzybowski M, Martin GB et al. Vasopressin canincrease coronary perfusion pressure during human cardiopulmonary resuscitation. Acad Emerg Med 1997; 4: 878-883.

44. Wenzel V, Krismer AC, Miller EA et al. Repeated administration of vasopressin but not epinephrine maintains coronary perfusion pressure after early and late administration during prolonged cardiopulmonary resuscitation in pigs. Circulation 1999; 99: 1379-1384.

45. Wenzel V, Augenstein S, Voelckel W et al. Intraosseous vasopressin improves coronary perfusion pressure rapidly during cardiopulmonary resuscitation in pigs. Crit Care Med 1999; 27: 1565-1569.

46. Lindner KH, Strohmenger HU, Prengel AW et al. Randomized comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation. Lancet 1997; 349: 535-537.

47. Voelckel WG, Wenzel V, Bonatti J et al. Effects of vasopressin and epinephrine on splanchnic blood flow and renal function during and after cardiopulmonary resuscitation in pigs. Crit Care Med 2000; 28: 1083-1088.

48. Gold JA, Cullinane S, Chen J. Vasopressin as an alternative to norepinephrine in the treatment of milrinone-induced hypotension. Crit Care Med 2000; 28: 249-252.

49. Morales D, Madigan U, Cullinane S et al. Reversal by vasopressin of intractable hypotension in the late phase of hemorrhagic shock. Circulation 1990; 100: 226-9.

50. Morales DL, Gregg D, Helman DN et al. Arginine vasopressin in the treatment of 50 patients with postcardiotomy vasodilatory shock. Ann Thorac Surg 2000; 69: 102-106.

51. Rosenweig EB, Starc TJ, Chen JM et al. Intravenous arginine vasopressin in children with vasodilatory shock after cardiac surgery. Circulation 1999; 100: II 182-II 186.

52. Tsuneyoshi I, Yamada H, Kakihana Y et al. Hemodynamic and metabolic effects of low-dose vasopressin infusions in vasodilatory septic shock. Crit Care Med 2001: 29.

53. Kurtzman NA, Rogers PW, Boonjarern S et al. Effect of infusion of pharmacologic amounts of vasopressin on renal electrolyte excretion. Am J Physiol 1975; 228: 890-894.

54. Shelly MP, Greatorex R, Calne RY et al. The physiological effects of vasopressin when used to control intra-abdominal bleeding. Intensive Care Med 1988; 14: 526-531.