Vasopressin therapy for vasoplegic syndrome following cardiopulmonary bypass.

Abstract

BACKGROUND:

Hypotension refractory to maximal doses of alpha-adrenergic drugs after cardiac operations employing cardiopulmonary bypass (CPB) has been referred as "vasoplegic syndrome." Vasopressin has been used for its therapy with encouraging results.

MATERIAL AND METHODS:

16 patients (mean age 71, range 47 to 84 years) were treated with intravenous vasopressin (0.1-1 IU/min) for hypotension refractory to maximal doses (>30 microg/kg/min) of norepinephrine after undergoing complex cardiac operations employing CPB. Preoperative ejection fraction was 40.5% (mean, range 20% to 60%), preoperative NYHA class was 3.5 (mean). Hemodynamic measurements were obtained one hour before and one hour after beginning vasopressin infusion; urine output was measured for the 4 hours before and the 4 hours after beginning the infusion. Duration of vasopressin treatment was 58.8 +/- 37.3 hours (mean +/- SD).

RESULTS:

Systolic blood pressure increased from 89.6 +/- 7.9 to 119.6 +/- 10.5 mmHg (mean +/- SD) (p < 0.001); systemic vascular resistance increased from 688.0 +/- 261.7 to 1043.3 +/- 337.1 dyne/s/cm2 (mean +/- SD) (p < 0.001); cardiac index decreased from 2.69 +/- 0.8 to 2.2 +/- 0.5 L/min/m2 (mean +/- SD) (p < 0.008); urine output increased from 36.8 +/- 30.4 to 72.8 +/- 38.2 mL/h (mean +/- SD) (p < 0.001). Seven patients (44%) survived the hospital stay.

CONCLUSIONS:

High-dose vasopressin is effective in the treatment of the vasoplegic syndrome after cardiac operations employing cardiopulmonary bypass.

• Authors: Paolo Masetti, Suzan F Murphy, Nicholas T Kouchoukos
• Journal: Journal of cardiac surgery (J Card Surg) 2002 Nov-Dec Vol. 17 Issue 6 Pg. 485-9 ISSN: 0886-0440 [Print] United States
• PMID: 12643457 (Publication Type: Journal Article)

Chemical References

• Adrenergic alpha-Agonists
• Adrenergic alpha-Antagonists
• Vasoconstrictor Agents
• Vasopressins

Topics

• Adrenergic alpha-Agonists (therapeutic use)
• Adrenergic alpha-Antagonists (therapeutic use)
• Aged
• Aged, 80 and over
• Blood Pressure (drug effects)
• Cardiac Output (drug effects)
• Cardiopulmonary Bypass
• Female
• Hospital Mortality
• Humans
• Hypotension (etiology)
• Infusions, Intravenous
• Male
• Middle Aged
• Paralysis (mortality, physiopathology, therapy)
• Postoperative Complications (etiology, mortality, physiopathology)
• Reoperation
• Syndrome
• Systole (drug effects)
• Treatment Outcome
• Vascular Resistance (drug effects)
• Vasoconstrictor Agents (therapeutic use)
• Vasopressins (therapeutic use)