Vasopressors: Do they have any role in hemorrhagic shock?

Babita Gupta, Neha Garg, Rashmi Ramachandran, Babita Gupta, Neha Garg, Rashmi Ramachandran

Abstract

The priority in the management of patients with traumatic hemorrhagic shock is to control the bleeding with simultaneous volume resuscitation to maintain adequate tissue perfusion. Fluid replacement remains the mainstay of initial resuscitation in hemorrhagic shock. Traditionally, vasopressors are contraindicated in the early management of hemorrhagic shock due to their deleterious consequences, although vasopressors may have a role in resuscitation when vasoplegic shock ensues and blood pressure cannot be maintained by fluids alone. Use of vasopressors is not recommended according to the Advanced Trauma Life SupportR management principles. The role of vasopressors remains controversial with no clear guidelines on the timing, type, and dose of these drugs in hemorrhagic shock. Among vasopressors, norepinephrine and vasopressin have been used in the majority of the trials, although not many studies compare the effect of these two on long-term survival in trauma patients. This article reviews the pathophysiology of hemorrhagic shock, adverse effects of fluid resuscitation, and the various experimental and clinical studies on the use of vasopressors in the early phase of resuscitation in hemorrhagic shock.

Keywords: Hemorrhagic; norepinephrine; shock; vasopressin; vasopressor agents.

Conflict of interest statement

There are no conflicts of interest.

References

    1. World Health Organization. Department of Injuries and Violence Prevention. Noncommunicable Diseases and Mental Health Cluster. Geneva: World Health Organization; 2002. [Last accessed on 2015 Dec 20]. Injury Chart Book. A Graphical Overview of the Global Burden of Injuries. Available from:
    1. World Health Organization. World Health Statistics 2009: Cause-specific Mortality and Morbidity. 2009. [Last accessed on 2015 May 16]. Available from: .
    1. Cothren CC, Moore EE, Hedegaard HB, Meng K. Epidemiology of urban trauma deaths: A comprehensive reassessment 10 years later. World J Surg. 2007;31:1507–11.
    1. Sperry JL, Minei JP, Frankel HL, West MA, Harbrecht BG, Moore EE, et al. Early use of vasopressors after injury: Caution before constriction. J Trauma. 2008;64:9–14.
    1. Collier B, Dossett L, Mann M, Cotton B, Guillamondegui O, Diaz J, et al. Vasopressin use is associated with death in acute trauma patients with shock. J Crit Care. 2010;25:173e.9–14.
    1. Fangio P, Asehnoune K, Edouard A, Smail N, Benhamou D. Early embolization and vasopressor administration for management of life-threatening hemorrhage from pelvic fracture. J Trauma. 2005;58:978–84.
    1. Advanced Trauma Life Support. 9th ed. Chicago, IL: American College of Surgeons; 2012. American College of Surgeons.
    1. Toung T, Reilly PM, Fuh KC, Ferris R, Bulkley GB. Mesenteric vasoconstriction in response to hemorrhagic shock. Shock. 2000;13:267–73.
    1. Schadt JC, Ludbrook J. Hemodynamic and neurohumoral responses to acute hypovolemia in conscious mammals. Am J Physiol. 1991;260(2 Pt 2):H305–18.
    1. Sharma RM, Setlur R. Vasopressin in hemorrhagic shock. Anesth Analg. 2005;101:833–4.
    1. Dalibon N, Schlumberger S, Saada M, Fischler M, Riou B. Haemodynamic assessment of hypovolaemia under general anaesthesia in pigs submitted to graded haemorrhage and retransfusion. Br J Anaesth. 1999;82:97–103.
    1. Shenkar R, Coulson WF, Abraham E. Hemorrhage and resuscitation induce alterations in cytokine expression and the development of acute lung injury. Am J Respir Cell Mol Biol. 1994;10:290–7.
    1. Madigan MC, Kemp CD, Johnson JC, Cotton BA. Secondary abdominal compartment syndrome after severe extremity injury: Are early, aggressive fluid resuscitation strategies to blame? J Trauma. 2008;64:280–5.
    1. Handy JM, Soni N. Physiological effects of hyperchloraemia and acidosis. Br J Anaesth. 2008;101:141–50.
    1. Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: A randomised controlled trial. Lancet. 2002;359:1812–8.
    1. Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, et al. Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens: A randomized assessor-blinded multicenter trial. Ann Surg. 2003;238:641–8.
    1. Acosta JA, Yang JC, Winchell RJ, Simons RK, Fortlage DA, Hollingsworth-Fridlund P, et al. Lethal injuries and time to death in a level I trauma center. J Am Coll Surg. 1998;186:528–33.
    1. Eberhard LW, Morabito DJ, Matthay MA, Mackersie RC, Campbell AR, Marks JD, et al. Initial severity of metabolic acidosis predicts the development of acute lung injury in severely traumatized patients. Crit Care Med. 2000;28:125–31.
    1. Manley G, Knudson MM, Morabito D, Damron S, Erickson V, Pitts L. Hypotension, hypoxia, and head injury: Frequency, duration, and consequences. Arch Surg. 2001;136:1118–23.
    1. Smaïl N, Descorps Declère A, Duranteau J, Vigué B, Samii K. Left ventricular function after severe trauma. Intensive Care Med. 1996;22:439–42.
    1. Eltzschig HK, Carmeliet P. Hypoxia and inflammation. N Engl J Med. 2011;364:656–65.
    1. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296–327.
    1. Gelman S, Mushlin PS. Catecholamine-induced changes in the splanchnic circulation affecting systemic hemodynamics. Anesthesiology. 2004;100:434–9.
    1. Meybohm P, Renner J, Boening A, Cavus E, Gräsner JT, Grünewald M, et al. Impact of norepinephrine and fluid on cerebral oxygenation in experimental hemorrhagic shock. Pediatr Res. 2007;62:440–4.
    1. Poloujadoff MP, Borron SW, Amathieu R, Favret F, Camara MS, Lapostolle F, et al. Improved survival after resuscitation with norepinephrine in a murine model of uncontrolled hemorrhagic shock. Anesthesiology. 2007;107:591–6.
    1. Meier J, Pape A, Loniewska D, Lauscher P, Kertscho H, Zwissler B, et al. Norepinephrine increases tolerance to acute anemia. Crit Care Med. 2007;35:1484–92.
    1. Harrois A, Baudry N, Huet O, Kato H, Dupic L, Lohez M, et al. Norepinephrine decreases fluid requirements and blood loss while preserving intestinal villi microcirculation during fluid resuscitation of uncontrolled hemorrhagic shock in mice. Anesthesiology. 2015;122:1093–102.
    1. Voelckel WG, Lurie KG, Lindner KH, Zielinski T, McKnite S, Krismer AC, et al. Vasopressin improves survival after cardiac arrest in hypovolemic shock. Anesth Analg. 2000;91:627–34.
    1. Stadlbauer KH, Wagner-Berger HG, Raedler C, Voelckel WG, Wenzel V, Krismer AC, et al. Vasopressin, but not fluid resuscitation, enhances survival in a liver trauma model with uncontrolled and otherwise lethal hemorrhagic shock in pigs. Anesthesiology. 2003;98:699–704.
    1. Raedler C, Voelckel WG, Wenzel V, Krismer AC, Schmittinger CA, Herff H, et al. Treatment of uncontrolled hemorrhagic shock after liver trauma: Fatal effects of fluid resuscitation versus improved outcome after vasopressin. Anesth Analg. 2004;98:1759–66.
    1. Voelckel WG, Raedler C, Wenzel V, Lindner KH, Krismer AC, Schmittinger CA, et al. Arginine vasopressin, but not epinephrine, improves survival in uncontrolled hemorrhagic shock after liver trauma in pigs. Crit Care Med. 2003;31:1160–5.
    1. Cossu AP, Mura P, De Giudici LM, Puddu D, Pasin L, Evangelista M, et al. Vasopressin in hemorrhagic shock: A systematic review and meta-analysis of randomized animal trials. Biomed Res Int. 2014;2014:421291.
    1. Alspaugh DM, Sartorelli K, Shackford SR, Okum EJ, Buckingham S, Osler T. Prehospital resuscitation with phenylephrine in uncontrolled hemorrhagic shock and brain injury. J Trauma. 2000;48:851–63.
    1. Feinstein AJ, Patel MB, Sanui M, Cohn SM, Majetschak M, Proctor KG. Resuscitation with pressors after traumatic brain injury. J Am Coll Surg. 2005;201:536–45.
    1. Plurad DS, Talving P, Lam L, Inaba K, Green D, Demetriades D. Early vasopressor use in critical injury is associated with mortality independent from volume status. J Trauma. 2011;71:565–70.
    1. Cohn SM, McCarthy J, Stewart RM, Jonas RB, Dent DL, Michalek JE. Impact of low-dose vasopressin on trauma outcome: Prospective randomized study. World J Surg. 2011;35:430–9.
    1. Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, et al. Management of bleeding and coagulopathy following major trauma: An updated European guideline. Crit Care. 2013;17:R76.
    1. Djogovic D, MacDonald S, Wensel A, Green R, Loubani O, Archambault P, et al. Vasopressor and inotrope use in Canadian Emergency Departments: Evidence based consensus guidelines. CJEM. 2015;17(Suppl 1):1–16.
    1. Tsuneyoshi I, Onomoto M, Yonetani A, Kanmura Y. Low-dose vasopressin infusion in patients with severe vasodilatory hypotension after prolonged hemorrhage during general anesthesia. J Anesth. 2005;19:170–3.
    1. Krismer AC, Wenzel V, Voelckel WG, Innerhofer P, Stadlbauer KH, Haas T, et al. Employing vasopressin as an adjunct vasopressor in uncontrolled traumatic hemorrhagic shock. Three cases and a brief analysis of the literature. Anaesthesist. 2005;54:220–4.

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