Why do we use vasopressin?

 April 30

by Jonathan Downham

Vasopressin, also known as antidiuretic hormone (ADH), plays a crucial role in regulating blood pressure in critically ill patients through its effects on the cardiovascular system. Here's how vasopressin helps maintain blood pressure in physiological terms:

  1. Vasoconstriction: Vasopressin acts directly on blood vessels, causing them to constrict. This vasoconstrictive effect increases peripheral vascular resistance, which is the resistance to blood flow in the small arteries and arterioles throughout the body. By increasing vascular resistance, vasopressin helps to elevate blood pressure.
  2. Water reabsorption: In addition to its vasoconstrictive effects, vasopressin acts on the kidneys to promote water reabsorption. It does this by increasing the permeability of the collecting ducts in the kidneys to water. As a result, more water is reabsorbed from the urine back into the bloodstream, leading to a decrease in urine output. This helps to increase blood volume and subsequently blood pressure.
  3. Redistribution of blood flow:
  4. a. Vasoconstriction of non-essential vascular beds: When the body experiences a drop in blood pressure, as commonly seen in critically ill patients with conditions like septic shock, vasopressin is released to help restore blood pressure and ensure perfusion to vital organs. One of the key mechanisms through which vasopressin achieves this is by causing vasoconstriction in non-essential vascular beds. These non-essential areas include the skin, muscles, and gastrointestinal tract. By constricting blood vessels in these regions, vasopressin redirects blood flow away from these less critical areas towards essential organs like the brain, heart, and kidneys. This prioritization of blood flow helps to maintain adequate oxygenation and nutrient delivery to vital tissues, despite the overall decrease in blood pressure.

    b. Preservation of perfusion to vital organs: In states of shock, such as septic shock, there is a systemic vasodilation that leads to a decrease in systemic vascular resistance. This vasodilation contributes to a decrease in blood pressure and can impair perfusion to vital organs. Vasopressin counteracts this vasodilation by inducing vasoconstriction, particularly in the splanchnic circulation (blood vessels supplying the gastrointestinal tract), skeletal muscles, and cutaneous circulation (blood vessels supplying the skin). By shunting blood away from these areas, vasopressin helps to maintain perfusion to crucial organs such as the brain and heart, which are essential for survival.

    c. Maintenance of cerebral and coronary perfusion: One of the critical roles of vasopressin in redistributing blood flow is to ensure adequate perfusion to the brain and heart. During states of shock, maintaining perfusion to these organs is paramount to prevent ischemic injury and organ dysfunction. Vasopressin's vasoconstrictive effects help to maintain cerebral and coronary perfusion pressure by preserving blood flow to these vital organs. This is particularly important in critically ill patients where cerebral and cardiac function must be safeguarded to prevent further deterioration.

Some reading for you-

  • This study compares the use of vasopressin versus norepinephrine infusion in patients with septic shock, highlighting the role of vasopressin in managing hemodynamic instability in critically ill patients.
  • This study compares the efficacy of dopamine and norepinephrine in the treatment of shock, which indirectly addresses the role of vasopressin as an alternative vasopressor agent in critically ill patients.
  • The VANISH trial investigates the effect of early vasopressin versus norepinephrine on kidney failure in patients with septic shock, providing insights into the renal effects of vasopressin therapy in critically ill patients.

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