Vasopressin drip rates

[GA8314]

So, I need to make sure I'm not losing my mind. But, during residency I recall running vasopressin at 0.5 to 1 U/Min (yes minute) for short periods of time coming off of a long bypass run on a tough patient.

Literature suggests max of 0.1u/Min.

Am I imagining things here? I'm 99% positive we did this and I had some great cardiac attendings. It was not a common thing but when running Milrinone and for long repairs (aortic dissections for example), we did need to run pretty aggressively.

Thoughts?

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[NICMAN]

We run max of 0.04 u/min. Higher and I think you run the risk of gut ischemia. Additionally coronary arteries have a high density of V1 receptors so non-bypassed vessels might have vasoconstricted blood flow that might lead to ischemia.

 

[Planktonmd]

That is a very large dose my friend, the patient will most likely look like a cadaver due to severe peripheral vasoconstriction and many organs will not get any blood flow.

 

[anbuitachi]

If its high dose infusion for short periods of time, how is that different from intermittent boluses of vasopressin?

 

[Maverikk]

That is a high dose, maybe reasonable for short periods of time immediately post bypass. Bad idea to continue it otherwise as it vasoconstricts the splanchnic/pulmonary circulation to higher degree than norepinephrine. The 0.04 u/min number comes from physiological depletion of vasopressin in septic shock vs. cardiogenic. The VAAST trial showed a (non-significant) trend to decreased mortality when it was added to NE however with increased digital ischemia. Surviving Sepsis guidelines added it as an adjunctive at 0.03 u/min.

My view: it's a great adjunctive when your NE starts going through the roof, more balanced vasoconstrict, but I would only use it in septic shock & possibly post-bypass as long as it was a distributive shock vs. a cardiac problem. I don't titrate it.

 

[GA8314]

Gosh, maybe we were running it at 0.1 u/min. not 1u/min
Haven't run a Vaso gtt since residency

 

[WholeLottaGame7]

Gosh, maybe we were running it at 0.1 u/min. not 1u/min
Haven't run a Vaso gtt since residency

I think so. 1 unit per minute???

We were 0.04u/min and leave it, occasionally .06 or .08 for short periods of time (post-bypass, releasing clamps, etc)

 

[vector2]

Gosh, maybe we were running it at 0.1 u/min. not 1u/min
Haven't run a Vaso gtt since residency

Some institutions also run 2.4-6 units/hour instead of 0.04-0.1 units per minute. Maybe your whole number came from a dosing scheme using those kind of rates.

 

[dchz]

Gonna leave this right here:

https://forums.studentdoctor.net/threads/dchzs-discussions-1-you-dont-titrate-vasopressin.1282096/