Most Read Articles
3 days ago
Combining the DASH (Dietary Approaches to Stop Hypertension) diet with low sodium intake reduces systolic blood pressure (SBP) in individuals with pre- and stage 1 hypertension, with progressively higher reductions at greater levels of baseline SBP, a recent study has shown.
Tristan Manalac, Yesterday
Major depressive disorder (MDD) appears to be more prevalent in females than in males, particularly in those who are divorced or widowed, a recent study from Singapore has found.
6 days ago
Cognitive deficits in bipolar disorder are neurodevelopmental rather than neurodegenerative in nature, a recent study has reported. Furthermore, cognitive impairment in bipolar patients appears to be stable, in the majority at least.
3 days ago
Tadalafil may not be effective for reducing the decline in ambulatory ability in boys with Duchenne muscular dystrophy (DMD), as shown in a recent study.

Selepressin shows promise in septic shock management

Audrey Abella
30 Aug 2017

The novel V1A-selective vasopressin receptor agonist selepressin may be an effective substitute for the traditional vasopressor norepinephrine in patients in early septic shock, a recent study has found.

In this double-blind multicentre trial, 53 patients in early septic shock were randomized to receive one of three ascending infusion rates of selepressin (1.25 ng/kg/min [n=10], 2.5 ng/kg/min [n=19], or 3.75 ng/kg/min [n=2]) or placebo (n=21) until shock resolution or a maximum 7 days.

At 24 hours, more patients given 2.5 ng/kg/min selepressin (about 70 percent) maintained a mean arterial pressure (MAP) of >60 mmHg without norepinephrine compared with those on 1.25 ng/kg/min selepressin (<20 percent) and placebo (20 percent).

Compared with placebo, use of selepressin 2.5 ng/kg/min resulted in the rapid reduction of norepinephrine mean infusion rate (0.04 vs 0.18 μg/kg/min at 24 hours), reduction of cumulative net fluid balance from day 5 onwards (p<0.05), and a higher proportion of days alive and free of ventilation (54 percent vs. 23 percent; p<0.02). [Crit Care 2017;doi:10.1186/s13054-017-1798-7]

“[A]t an infusion rate of 2.5 ng/kg/minute, [selepressin] rapidly replaced norepinephrine while maintaining target MAP and may have improved fluid balance and shortened the time of mechanical ventilation,” said the researchers.

“Reducing the dose of norepinephrinecould in itself be advantageous because it could decrease the adverse effects of norepinephrine … [and] have beneficial effects on fluid balance and vascular leak,” they said.

The greater proportion of patients weaned off norepinephrine during the first 24 hours and the decreased mean cumulative norepinephrine dose demonstrate rapid onset and sustained activity, suggesting selepressin to be a potent vasopressor, noted the researchers.

Furthermore, the reduced mechanical ventilation period reflects selepressin’s potential in mitigating the risks associated with long periods of mechanical ventilation such as nosocomial pneumonia, neuromuscular weakness, and mortality, they added.

As this was the first inpatient trial of selepressin in septic shock patients and owing to the small sample size which could have limited the overall impact, more investigation is warranted to evaluate the potential of selepressin in improving treatment outcomes in septic shock patients, said the researchers.

The ongoing SEPSIS-ACT* trial is assessing the superiority of rapid and full substitution of norepinephrine with selepressin over cotreatment with selepressin and norepinephrine, noted the researchers.

“[T]he potential additional benefits of selepressin compared with vasopressin … may justify earlier use and fuller substitution of norepinephrine with selepressin,” they said.

 

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
3 days ago
Combining the DASH (Dietary Approaches to Stop Hypertension) diet with low sodium intake reduces systolic blood pressure (SBP) in individuals with pre- and stage 1 hypertension, with progressively higher reductions at greater levels of baseline SBP, a recent study has shown.
Tristan Manalac, Yesterday
Major depressive disorder (MDD) appears to be more prevalent in females than in males, particularly in those who are divorced or widowed, a recent study from Singapore has found.
6 days ago
Cognitive deficits in bipolar disorder are neurodevelopmental rather than neurodegenerative in nature, a recent study has reported. Furthermore, cognitive impairment in bipolar patients appears to be stable, in the majority at least.
3 days ago
Tadalafil may not be effective for reducing the decline in ambulatory ability in boys with Duchenne muscular dystrophy (DMD), as shown in a recent study.