Role of exogenous arginine vasopressin in the management of catecholamine-refractory septic shock

Septic shock that remains refractory to fluid replacement and continuous high-dose catecholamines is associated with a high mortality rate and requires an exhaustive management strategy that matches the complexity of the illness. The effects of exogenous arginine vasopressin include restoration of MAP and catecholamine vasopressor sparing in septic shock. Use of vasopressin in the treatment of septic shock should be limited to continuous infusions of no more than 0.04 units/min and should be confined to patients with catecholamine-refractory septic shock. Adverse reactions associated with the use of arginine vasopressin include decreases in cardiac index, heart rate, and end-organ perfusion. Patients who require exogenous arginine vasopressin, particularly patients with cardiac dysfunction, require vigilant monitoring for signs and symptoms of decreased cardiac output and alterations in tissue perfusion.