Vasopressin in a patient with hypovolemia

[Protoman2050]

In a patient with severe hypovolemia, or acute right heart failure, would giving vasopressin (along with Nitropress in the latter case, to counteract its vasoconstrictive effect so it's ADH effect can predominate...don't want to increase RV afterload) be of use?

Or would simply flooding the pt w/ IV LR be simpler, cheaper, and more predictable?

 

[Crepitus]

In a patient with severe hypovolemia, or acute right heart failure, would giving vasopressin (along with Nitropress in the latter case, to counteract its vasoconstrictive effect so it's ADH effect can predominate...don't want to increase RV afterload) be of use?

Or would simply flooding the pt w/ IV LR be simpler, cheaper, and more predictable?

As I recall there was interest in using AVP for trauma (during the 90's maybe), typically it was secondary to the catecholamine vasopressors.

There was a Vanderbilt study this summer though that essentially said the use of Vasopressin should be reconsidered in trauma patients as the end mortality rate was higher with it's use.

Is that what you are asking?

 

[usalsfyre]

I understand where your going with this but, patient who is solely volume depleted (i.e. not losing whole blood) needs fluid, no matter how severely they are dehydrated. Fluid to restore circulatory status, then work on the underlying cause.

 

[Protoman2050]

As I recall there was interest in using AVP for trauma (during the 90's maybe), typically it was secondary to the catecholamine vasopressors.

There was a Vanderbilt study this summer though that essentially said the use of Vasopressin should be reconsidered in trauma patients as the end mortality rate was higher with it's use.

Is that what you are asking?

Yes. How long does it take for vasopressin to increase intravascular volume due to its water reabsorbing effect?

 

[Protoman2050]

I understand where your going with this but, patient who is solely volume depleted (i.e. not losing whole blood) needs fluid, no matter how severely they are dehydrated. Fluid to restore circulatory status, then work on the underlying cause.

Ah. That makes far more sense.

 

[Jersey]

Now lets remember that vasopressors do not work unless there is volume to back it up. With a patient where it is just a "space" issue, no volume has been lost. However since the container is bigger, filling it with fluid AND using a vasopressor dobutamine/dopamine leads to 1) less vasopressor needed *synergistic effect between pressor and fluids and 2) more efficient and quicker raise in BP. This is because if you fill the container before using a pressor, the vessel will not have to contract as far to return BP to a normal range. hope that helps?

Cheers,
Jersey

 

[Protoman2050]

Now lets remember that vasopressors do not work unless there is volume to back it up. With a patient where it is just a "space" issue, no volume has been lost. However since the container is bigger, filling it with fluid AND using a vasopressor dobutamine/dopamine leads to 1) less vasopressor needed *synergistic effect between pressor and fluids and 2) more efficient and quicker raise in BP. This is because if you fill the container before using a pressor, the vessel will not have to contract as far to return BP to a normal range. hope that helps?

Cheers,
Jersey

Yes, that makes a lot of sense.