Vasopressin in Patients with Septic Shock and Dynamic Left Ventricular Outflow Tract Obstruction
The result's identifiers
Result code in IS VaVaI
<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00216208%3A11110%2F20%3A10415180" target="_blank" >RIV/00216208:11110/20:10415180 - isvavai.cz</a>
Alternative codes found
RIV/00064165:_____/20:10415180
Result on the web
<a href="https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=cO6k-kf4pj" target="_blank" >https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=cO6k-kf4pj</a>
DOI - Digital Object Identifier
<a href="http://dx.doi.org/10.1007/s10557-020-06998-8" target="_blank" >10.1007/s10557-020-06998-8</a>
Alternative languages
Result language
angličtina
Original language name
Vasopressin in Patients with Septic Shock and Dynamic Left Ventricular Outflow Tract Obstruction
Original language description
Purpose: Left ventricular outflow tract obstruction (LVOTO) is a relatively uncommon but severe condition that may lead to hemodynamic impairment. It can be elicited by morphological (left ventricular hypertrophy, sigmoid septum, prominent papillary muscle, prolonged anterior mitral valve leaflet) and functional (hypovolemia, low afterload, hypercontractility, catecholamines) factors. We sought to determine the incidence of the most severe form of LVOTO in septic shock patients and describe the therapeutic effects of vasopressin. Methods: Over a period of 29 months, 527 patients in septic shock were screened for LVOTO. All were mechanically ventilated and treated according to sepsis bundles, including pre-load optimization and norepinephrine infusion. Vasopressin was added in addition to norepinephrine to reduce the adrenergic burden and decrease LVOTO. Results: Ten patients were diagnosed with the most severe form of LVOTO, including systolic anterior mitral valve motion (SAM) and severe mitral regurgitation (MR) with pulmonary oedema. The median norepinephrine dosage to obtain a mean arterial pressure of >=70 mmHg was 0.58 mcg/Kg/min (IQR 0.40-0.78). All patients had a hyper-contractile left ventricle, septal hypertrophy, significant LVOTO (peak gradient 78 [56-123] mmHg) associated with SAM and severe MR with pulmonary oedema. Vasopressin (median 4 IU/h) allowed a significant reduction of norepinephrine (0.18 [0.14-0.30] mcg/kg/min; p = 0.01), LVOT gradient (35 [24-60] mmHg; p = 0.01) and MR with a significant paO2/FiO2 increase (174 [125-213] mmHg; p = 0.01). Conclusion: Vasopressin allowed a reduction of norepinephrine with subsequent LVOTO reduction and hemodynamic improvement of the most severe form of LVOTO, which represented 1.9% of all septic shock patients.
Czech name
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Czech description
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Classification
Type
J<sub>imp</sub> - Article in a specialist periodical, which is included in the Web of Science database
CEP classification
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OECD FORD branch
30201 - Cardiac and Cardiovascular systems
Result continuities
Project
<a href="/en/project/NV18-06-00417" target="_blank" >NV18-06-00417: Prospective randomized double-blind study of efficacy and safety of 1c class antiarrhythmic agent (propafenone) for supraventricular arrhythmias in septic shock</a><br>
Continuities
V - Vyzkumna aktivita podporovana z jinych verejnych zdroju
Others
Publication year
2020
Confidentiality
S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů
Data specific for result type
Name of the periodical
Cardiovascular Drugs and Therapy
ISSN
0920-3206
e-ISSN
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Volume of the periodical
34
Issue of the periodical within the volume
5
Country of publishing house
US - UNITED STATES
Number of pages
4
Pages from-to
685-688
UT code for WoS article
000537399800002
EID of the result in the Scopus database
2-s2.0-85085889203