To the Editor:—

We read with great interest the report by Patel et al.  on beneficial effects of short-term infusion of vasopressin for severe septic shock. 1The authors reported that for 24 patients with severe septic shock, 4 h infusion of vasopressin spared norepinephrine to maintain mean arterial pressure and improved urine output and creatinine clearance compared with the control group (norepinephrine infusion) in a double-blinded, randomized, controlled fashion. We were impressed with the results showing that low-dose vasopressin therapy may increase survival of septic shock. However, there was no information about the outcome of their patients. To survive from severe septic shock, there may be a need for long-term vasopressin infusion to maintain stable cardiovascular status. Dunser et al.  demonstrates 72-h vasopressin infusion brings about a significant increase in liver enzymes and total bilirubin concentration and a significant decrease in platelet count. 2 

Patel BM, Chittock DR, Russell JA, Walley KR: Beneficial effects of short-term vasopressin infusion during severe septic shock. A nesthesiology 2002; 96: 576–82
Dunser MW, Mayr AJ, Ulmer H, Ritsch N, Knotzer H, Pajk W, Luckner G, Mutz NJ, Hasibeder WR: The effects of vasopressin on systemic hemodynamics in catecholamine-resistant septic and postcardiotomy shock: a retrospective analysis. Anesth and Analg 2001; 93: 7–13