Terlipressin versus adrenaline in refractory septic shock

Heba A Labib, Niven G Fahmy, Tamer Y Elie Hamawy

Ain-Shams Journal of Anaesthesiology 2016 9(2):186-193

Objective The aim of this study was to compare terlipressin versus adrenaline in refractory septic shock. Patients and methods In this interventional prospective randomized study, 80 patients between 18 and 60 years of age who presented with refractory septic shock were enrolled. The patients were divided randomly into two groups of 40 patients each. Group A patients were treated with adrenaline and group T patients were treated with terlipressin. The goals of the therapy were to achieve and maintain for 6 h all of the following: (i) mean blood pressure greater than 65 mmHg; (ii) systemic vascular resistance index greater than 1300 dynes s/cm 5 /m 2 ; (iii) cardiac index (CI) greater than 4.0 l/min/m 2 ; and (iv) oxygen delivery index greater than 550 ml/min/m 2 . The patients were classified into responders and nonresponders to the drugs used. Results The number of responders was significantly higher in the terlipressin group. There were 23 (58.97%) responders in the T group and 13 (35.13%) responders in the A group. The terlipressin group showed a significant increase in mean blood pressure from 49.9 ± 14.82 to 77.79 ± 20 mmHg and a significant increase in systemic vascular resistance index from 898 ± 292 to 1420 ± 537 dynes s/cm 5 /m 2 ; urine output and creatinine clearance also showed an increase. Group T patients showed a significant decrease in heart rate and norepinephrine infusion. As regards cardiac index and oxygen delivery index, they showed minimal decrease at the end of the study, but their levels were still above our target levels. Conclusion Terlipressin therapy is better than adrenaline in improving the hemodynamic variables and kidney functions in refractory septic-shock patients.

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