Vasopressin as adjunct vasopressor for vasodilatory shock due to non-occlusive mesenteric ischemia.
We present the case of an 83-year-old patient who underwent cardiac surgery and developed postoperative non-occlusive mesenteric ischemia (NOMI), which was treated with a local intra-arterial papaverine and prostaglandin E1 infusion. After successful mesenteric reperfusion, a multiple organ dysfunction syndrome with severe cardiovascular failure developed. High norepinephrine dosages (1.09 microg/kg body weight/min) and catecholamine-related complications (tachycardiac atrial fibrillation) required initiation of supplementary argininevasopressin (AVP) infusion (4 U/h). AVP stabilized vasodilatory shock, ensured adequate gut perfusion pressure and had no adverse clinical or angiographic effects on restitution of gut integrity. In conclusion, after reperfusion of NOMI in this patient, adjunct AVP therapy combined with local vasodilator infusion was beneficial as a potentially life-saving vasopressor.
Luckner
G
G
Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria. Guenter.Luck n er@uibk.ac.at
Jochberger
S
S
Mayr
V D
VD
Knotzer
H
H
Pajk
W
W
Wenzel
V
V
Friesenecker
B
B
Lorenz
I
I
Dünser
M W
MW
D000369:Aged, 80 and over; D001127:Arginine Vasopressin / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000139:chemically induced / Q000188:drug therapy; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D007511:Ischemia / Q000188:drug therapy* / Q000503:physiopathology; D009102:Multiple Organ Failure / Q000188:drug therapy / Q000209:etiology; D009638:Norepinephrine / Q000009:adverse effects / Q000627:therapeutic use; D010208:Papaverine / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy* / Q000503:physiopathology; D012769:Shock / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D013152:Splanchnic Circulation / Q000187:drug effects*; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000009:adverse effects* / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D001127:Arginine Vasopressin; D010208:Papaverine; D009638:Norepinephrine