Tasty Morsels of Critical Care Tasty Morsels of Critical Care 075 | Vasopressin
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Oct 30, 2023 This podcast explores the effects and mechanisms of vasopressin, highlighting its maxed-out effect at low doses and its role as a pure pressor at high doses. They also discuss its potential advantages as a vasopressor in ICU patients, its use in treating septic shock, and the findings of several trials and a meta-analysis.
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Vasopressin's Mechanism and Role
- Vasopressin is an ADH analog with similar effects but acts as a pure vasopressor at high doses used in septic shock.
- Its main vascular effect is via V1 receptors causing calcium release and increased vascular tone, distinct from catecholamines.
Vasopressin Receptors and Effects
- V1 receptor stimulation causes vasoconstriction including coronary arteries but tends to spare pulmonary arteries, potentially benefiting pulmonary hypertension patients.
- Other receptors like V2 and V3 mediate effects on kidneys and cortisol secretion but have less relevance in ICU vasopressor use.
Advantages of Using Vasopressin
- Vasopressin receptors remain effective in severe metabolic acidosis where catecholamines may lose effectiveness.
- Vasopressin causes less pulmonary artery constriction and may produce less tachyphylaxis compared to catecholamines.