• Bryan Collier, Lesly Dossett, Mindy Mann, Bryan Cotton, Oscar Guillamondegui, Jose Diaz, Sloan Fleming, Addison May, and John Morris.
• Division of Trauma and Surgical Critical Care, The Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA. bryan.collier@vanderbilt.edu
• J Crit Care. 2010 Mar 1;25(1):173.e9-14.

PurposeTraumatic hemodynamic instability is associated with high mortality if not expeditiously corrected. Hypotension despite adequate volume resuscitation is treated with vasopressors. Although catecholamines are typically the first agent used, arginine vasopressin (AVP) is increasingly been used as an adjuvant agent. Mortality with refractory hypotension and vasopressin use in trauma patients is unknown.Materials And MethodsA retrospective cohort analysis of trauma patients requiring vasopressors within 72 hours of admission was performed. Two groups were identified: patients who received AVP (AVP+) and those who did not (AVP-). Primary outcome was mortality.ResultsFive hundred thirty nine patients met the criteria with 189 patients receiving AVP. Demographics, Injury Severity Score, minimum hemoglobin, and blood volume resuscitation (packed red blood cell, fresh frozen plasma, and platelets) were similar between groups. Trauma and Injury Severity Score suggested a higher probability of survival in AVP+ (0.88 vs 0.73, P < .001); however, the observed mortality was higher (55% vs 41%, P = .002). The age, Injury Severity Score, initial lactate, and severe head injury adjusted odds ratio of death for AVP+ patients was 1.6 (95% confidence interval, 1.1-2.4; P = .02).ConclusionsArginine vasopressin is associated with increased mortality in trauma patients with refractory hypotension. Arginine vasopressin may be a marker of illness or possibly play a causal role in adverse outcomes. Clinicians should reconsider expanding the indications of AVP use.Copyright 2010 Elsevier Inc. All rights reserved.

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