Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery
Author:
Hajjar Ludhmila Abrahao1, Vincent Jean Louis1, Barbosa Gomes Galas Filomena Regina1, Rhodes Andrew1, Landoni Giovanni1, Osawa Eduardo Atsushi1, Melo Renato Rosa1, Sundin Marcia Rodrigues1, Grande Solimar Miranda1, Gaiotto Fabio A.1, Pomerantzeff Pablo Maria1, Dallan Luis Oliveira1, Franco Rafael Alves1, Nakamura Rosana Ely1, Lisboa Luiz Augusto1, de Almeida Juliano Pinheiro1, Gerent Aline Muller1, Souza Dayenne Hianae1, Gaiane Maria Alice1, Fukushima Julia Tizue1, Park Clarice Lee1, Zambolim Cristiane1, Rocha Ferreira Graziela Santos1, Strabelli Tânia Mara1, Fernandes Felipe Lourenco1, Camara Ligia1, Zeferino Suely1, Santos Valter Garcia1, Piccioni Marilde Albuquerque1, Jatene Fabio Biscegli1, Costa Auler Jose Otavio1, Filho Roberto Kalil1
Affiliation:
1. From the Surgical Intensive Care Unit, Department of Cardiopneumology (L.A.H., F.R.B.G.G., E.A.O., R.R.M., M.R.S., S.M.G., R.A.F., R.E.N., J.P.d.A., A.M.G., D.H.S., M.A.G., J.T.F., C.L.P., C.Z., G.S.R.F., F.L.F., L.C., S.Z., V.G.S.P., M.A.P., J.O.C.A.) and Divisions of Cardiovascular Surgery (F.A.G., P.M.P., L.O.D., L.A.L., F.B.J.), Infectious Diseases (T.M.S.), and Cardiology (R.K.F.), Heart Ins
Abstract
Abstract
Background
Vasoplegic syndrome is a common complication after cardiac surgery and impacts negatively on patient outcomes. The objective of this study was to evaluate whether vasopressin is superior to norepinephrine in reducing postoperative complications in patients with vasoplegic syndrome.
Methods
This prospective, randomized, double-blind trial was conducted at the Heart Institute, University of Sao Paulo, Sao Paulo, Brazil, between January 2012 and March 2014. Patients with vasoplegic shock (defined as mean arterial pressure less than 65 mmHg resistant to fluid challenge and cardiac index greater than 2.2 l · min−2 · m−2) after cardiac surgery were randomized to receive vasopressin (0.01 to 0.06 U/min) or norepinephrine (10 to 60 μg/min) to maintain arterial pressure. The primary endpoint was a composite of mortality or severe complications (stroke, requirement for mechanical ventilation for longer than 48 h, deep sternal wound infection, reoperation, or acute renal failure) within 30 days.
Results
A total of 330 patients were randomized, and 300 were infused with one of the study drugs (vasopressin, 149; norepinephrine, 151). The primary outcome occurred in 32% of the vasopressin patients and in 49% of the norepinephrine patients (unadjusted hazard ratio, 0.55; 95% CI, 0.38 to 0.80; P = 0.0014). Regarding adverse events, the authors found a lower occurrence of atrial fibrillation in the vasopressin group (63.8% vs. 82.1%; P = 0.0004) and no difference between groups in the rates of digital ischemia, mesenteric ischemia, hyponatremia, and myocardial infarction.
Conclusions
The authors’ results suggest that vasopressin can be used as a first-line vasopressor agent in postcardiac surgery vasoplegic shock and improves clinical outcomes.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Anesthesiology and Pain Medicine
Cited by
248 articles.
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