Vasopressin, when added to norepinephrine, was not associated with increased predicted mortality after cardiac surgery.
OBJECTIVE
Arginin vasopressin (AVP) is a potent vasoconstrictor which has been used in vasodilatory shock when therapy with catecholamines and fluids has failed. In this study we evaluated the association of AVP with organ failure and mortality in cardiac surgical patients suffering from vasodilatory shock refractory to norepinephrine (NE) treatment.


METHODS
Cardiac surgical patients who received AVP in addition to NE (N=33, AVP-group) and 33 control patients (NE group) who were treated with an equal dose of NE compared with AVP patients when AVP infusion started. Data on preoperative risk factors according to EuroSCORE and predicted mortality calculated by logistic EuroSCORE were collected preoperatively. Data on hemodynamics, organ dysfunctions, length of intensive care unit stay and mortality were collected.


RESULTS
EuroSCORE did not differ between the groups, AVP:10.4 +/- 3.9 vs. NE 8.9 +/- 4.0. Observed 30 day mortality was lower than predicted in both groups, AVP: 7 (21.7%) vs. predicted mortality 25.9% and NE: 2 (6.1%) vs. 16.0%, respectively. There were more renal complications (36.4% vs. 9.1%, p = 0.008) and infections (30.3% vs. 3.0%, p = 0.003) in patients receiving AVP. Cardiovascular complications did not differ between the groups.


CONCLUSIONS
In this prospectively observed cohort of cardiac surgical patients, AVP did not increase mortality predicted by Euroscore. Anyhow renal and infection complications were common.
Suojaranta-Ylinen
R T
RT
Department of Anesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland. raili.suojaranta-ylinen@hus.fi
Vento
A E
AE
Pätilä
T
T
Kukkonen
S I
SI
D000368:Aged; D001127:Arginine Vasopressin / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D011379:Prognosis; D012189:Retrospective Studies; D012773:Shock, Surgical / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D015996:Survival Rate / Q000639:trends; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin; D009638:Norepinephrine