Polydistrectual resistance index evaluation is an assessment of vascular compliance in patients with septic shock treated with vasopressin

Introduction Surviving Sepsis Campaign recomends using Norepinephrine (NE) as the first-line vasopressor to restore mean arterial pressure. If mean arterial pressure remains inadeguate SSC suggests adding Vasopressin (VA). Resistance Index (RI) is a Power Doppler ultrasound assessment of vascular compliance to detect organ perfusion. Methods Aim of this study is to compare RI in septic shock patients treated with NE (Group1),NE plus VA since the beginning of vasopressor therapy(Group2) and VA plus NE where VA is added if NE dosage was 20 mcg/min(Group3). RI were measured in Renal Artery (ARE),Radial Artery (AR),Central Retinal Artery (CRA),Superior Mesenteric Artery (AMS) at three different time points (T0) before vasopressor therapy,(T1) at 1 hr,T2 at 24 hrs and T3 at 48hrs. Results 48 patients were divided into three groups.17 patients Group1;16 Group 2,15 Group3. In Group 1 RI increased from T0 in CRA R[0,90(0,57–1,12)] and ARE L[0,74(0,56-0,92) to T3 in CRA R[0,97(0,97–1,14)] and ARE L[0,96(0,82–1,17)] In Group2 RI reduced in AMS, from T0[0,84(0.70,1.02)] to T3[0,75(0.59,0.81)],in CRA R, from T0[0,90(0.57,1.09] to T3[0,79(0.58, 0.87)],in CRA L,from T0[0,91(0.43,1.53)] to T3[0,76(0.58, 0.89]and in ARE L,from T0[0,79(0.58, 0.92)] to T3[0,72(0.59, 0.83)]. In Group3 RI reduced in AMS, from t0[0,86(0.71,0.93)] to T3 [0,68(0.64,0.81)],in CRA R,from T0 [0,90(0.75,1.12)] to T3 [0,78(0.66,0.88)],in CRA L,from T0[0.96(0.76,1.33)] to T3 [0,96(0.76,1.33)],in ARE L,from T0[0.77(0.66, 0.99)]to T3[0,67(0.61,0.85],in ARE R,from T0[0.82[0.64, 0.90]]to T3[0.70(0.62,0.82)] and in AR R,from T0[1,10(0.81,1.30)] to T3 [0.87(0.64,1.22)]. Discussion Resistence Index was singnificantly reduced in patients treated with early synergic administration of NE and VA .This strategy optimized multiorgan perfusion.