Vasopressin and its analogues during shock

Abstract

Arginine-vasopressin system is activated to face to a drop in blood pressure. Vasopressin, an endogenous stress hormone, induces vasoconstriction through the activation of V1a receptors located on vascular smooth muscle cells.
The rationale for vasopressin use during septic shock is related to relatively low vasopressin plasma levels, with a hypersensitivity to its vasopressor effect in vasodilatory shock. Terlipressin and selepressin are synthetic vasopressin analogues with a higher affinity for vascular receptors.
We present herein benefits and risks related to vasopressin use in the setting of septic shock and vasoplegic shock following cardiac surgery. Thus, vasopressin administration allows a reduction in norepinephrine requirements. In contrast, side effects are common, in particular digital ischemia.
Finally, we will discuss the current place for vasopressin and agonists in view of the available knowledge, and remaining unresolved questions.