Sublingual microcirculatory flow is impaired by the vasopressin-analogue terlipressin in a patient with catecholamine-resistant septic shock

For many decades arterial blood pressure regulation has been an important issue in the treatment of septic shock. The pathogenesis of this persistent hypotension is complex and multifactorial, but inability of vascular smooth muscle to contract in the presence of vasoconstrictive agents seems to be a key factor. Many mechanisms have been proposed to account for this failure, including nitric oxide (NO) overproduction and vasopressin deficiency (1). However, improvement of outcome due to intervention in these mechanisms fails to be reported despite the restoration of blood pressure. Recent studies of the microcirculation in humans by means of orthogonal polarization spectral (OPS) imaging have opened challenging new perspectives to study the microcirculation (2, 3). We report a case in which sublingual OPS imaging was performed upon administration of terlipressin in a patient with catecholamine-resistant septic shock. It indicates that much caution should be taken when considering such potent vasoconstrictor when correcting blood pressure during shock.