A comparative study between terlipressin alone and dobutamine and terlipressin in septic shock patients

Abstract EN

The use of terlipressin, a long-acting synthetic analog of vasopressin, is associated with reduction in cardiac output and oxygen delivery.

The present study was designed to determine whether dobutamine may reverse the terlipressininduced depression in central venous oxygen saturation (SvO2) in patients with catecholamine-dependent septic shock.

Patients and methods This clinical trial was conducted in Ain Shams University hospital’s surgical ICU.

In total, 90 septic shock patients requiring a continuous infusion of norepinephrine reaching 0.6 μg/kg/min to maintain mean arterial pressure at greater than or equal to 65 mmHg were randomly allocated to three groups be treated as follows: (i): group I, treated with norepinephrine infusion (control); (ii) group II, treated with a single bolus of terlipressin 1 mg, intravenous; (iii) and group III, treated with a single bolus of terlipressin 1 mg, followed by a dobutamine infusion.

Results The use of terlipressin (with and without dobutamine) resulted in maintaining mean arterial pressure above 65 mmHg with reduction in norepinephrine requirements to 0.2 (0.1) μg/kg/min in group II and 0.15 (0.1) μg/kg/min in group III (P in each<0.001 vs.

control at 2, 4, and 6 h).

The use of terlipressin alone in group II resulted in a drop in central SvO2 to 58 (3)% (P<0.001 vs.

control at 2, 4, and 6 h) and a decrease in heart rate to 105 beat/minute (7) (P vs.

control=0.013 at 2 h, 0.001 at 4 h, and 0.01 at 6 h).

The addition of dobutamine in group III resulted in an increase in central SvO2 to 70 (3)% (P<0.001 vs.

group II at 2, 4, and 6 h).

Conclusion Administration of terlipressin bolus was effective in increasing mean arterial blood pressure and reducing norepinephrine requirements in catecholamine-dependant septic shock patients.

Its use was associated with significant reductions in central SvO2, which was reversed by using dobutamine.