A double-blind randomized trial: prophylactic vasopressin reduces hypotension after cardiopulmonary bypass.
BACKGROUND
Inhibition of angiotensin-converting enzyme (ACE) predisposes patients to vasodilatory hypotension after cardiopulmonary bypass (CPB). This hypotension has been correlated with arginine vasopressin deficiency and can be corrected by its replacement. In patients receiving ACE inhibition, we investigated whether initiation of vasopressin before CPB would diminish post-CPB hypotension and catecholamine use by avoiding vasopressin deficiency.


METHODS
Cardiac surgical patients on ACE inhibitor therapy were randomized to receive vasopressin (0.03 U/min) (n = 13) or an equal volume of normal saline (n = 14) starting 20 minutes before CPB.


RESULTS
Vasopressin did not change pre-CPB mean arterial pressure or pulmonary artery pressure. After CPB, the vasopressin group had a lower peak norepinephrine dose than the placebo group (4.6 +/- 2.5 versus 7.3 +/- 3.5 microg/min, p = 0.03), a shorter period on catecholamines (5 +/- 6 versus 11 +/- 7 hours, p = 0.03), fewer hypotensive episodes (1 +/- 1 versus 4 +/- 2, p < 0.01), and a shorter intensive care unit length of stay (1.2 +/- 0.4 versus 2.1 +/- 1.4 days, p = 0.03).


CONCLUSIONS
In this cohort, prophylactic administration of vasopressin, at a dose without a vasopressor effect pre-CPB, reduced post-CPB hypotension and vasoconstrictor requirements, and was associated with a shorter intensive care unit stay.
Morales
David L S
DL
Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA. dlm36@columbia.edu
Garrido
Mauricio J
MJ
Madigan
John D
JD
Helman
David N
DN
Faber
Joseph
J
Williams
Mathew R
MR
Landry
Donald W
DW
Oz
Mehmet C
MC
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D001127:Arginine Vasopressin / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000517:prevention & control*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage; D011183:Postoperative Complications / Q000139:chemically induced / Q000517:prevention & control*; D011292:Premedication; D012307:Risk Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D001127:Arginine Vasopressin; D009638:Norepinephrine