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Review article: Organ perfusion/permeability-related effects of norepinephrine and vasopressin in sepsis

[Exposé de synthèse : Les effets reliés à la perfusion et à la perméabilité organique de la norépinéphrine et de la vasopressine durant le "sepsis"]

Paul Farand, MD MSc^*, Mélanie Hamel, MD^,, François Lauzier, MD^,, Gérard E. Plante, MD PhD^*, and Olivier Lesur, MD PhD^,

^* From the Laboratoire de Physiologie Rénale et
Vasculaire, Institut de Pharmacologie, Groupe de Recherche en Physiopathologie Respiratoire,
Unité des Soins Intensifs Médicaux; and the
Service de Néphrologie, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada.

Address correspondence to: Dr. Olivier Lesur, Centre de Recherche Clinique, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada. Fax: 819-564 5377; E-mail: olivier.lesur{at}USherbrooke.ca

Purpose: One invariable hallmark of severe sepsis is generalized tissue "malperfusion" and hyperpermeability secondary to microcirculatory/capillary leakage. This review focuses on direct and/or indirect influences of norepinephrine, as a standard of care, and vasopressin, as an alternative vasoactive drug, on organ and tissue perfusion/permeability in severe sepsis.

Source: English and French language articles and books published between 1966 and 2005 were identified through a computerized Medline search using the terms "sepsis, permeability, norepinephrine and vasopressin". Relevant publications were retrieved and scanned for additional sources.

Principal findings: There are few randomized clinical trials comparing different vasopressors in sepsis; most available literature consists of clinical reports, animal experiments and occasional reviews. Based on the best current evidence from these sources, we describe the status of major organ perfusion/permeability in sepsis (i.e., the lung, the kidney, the heart, the intestine/gut) in the context of sepsis-induced organ dysfunction/failure. Potential and differential therapeutic effects of the vasopressors norepinephrine and arginine-vasopressin, in the setting of sepsis, are identified.

Conclusions: In the treatment of sepsis, arginine-vasopressin exhibits organ-specific heterogeneity in vascular responsiveness, compared to norepinephrine. While norepinephrine is a current standard of care in sepsis, arginine-vasopressin shows promise for the treatment of septic shock.