Vasopressin improves hemodynamic status in infants with congenital diaphragmatic hernia.
OBJECTIVE
To assess the ability of vasopressin to stabilize hemodynamics in infants with systemic hypotension secondary to congenital diaphragmatic hernia (CDH).


METHODS
A retrospective chart review was performed to identify 13 patients with CDH treated with vasopressin for refractory hypotension to assess the effect of vasopressin on pulmonary and systemic hemodynamics and gas exchange in this setting. Data collected included demographics, respiratory support, inotropic agents, pulmonary and systemic hemodynamics, urine output, and serum and urine sodium levels during vasopressin therapy.


RESULTS
Vasopressin therapy increased mean arterial pressure and decreased pulmonary/systemic pressure ratio, heart rate, and fraction of inspired oxygen. In 6 of 13 patients, extracorporeal membrane oxygenation therapy was no longer indicated after treatment with vasopressin. Improvement in left ventricular function and oxygenation index after vasopressin initiation was associated with a decreased need for extracorporeal membrane oxygenation therapy. Prolonged vasopressin treatment was associated with hyponatremia, increased urine output, and increased urine sodium.


CONCLUSIONS
Vasopressin stabilized systemic hemodynamics without adverse effects on pulmonary hemodynamics in a subset of infants with CDH. Our results suggest a potential role for vasopressin therapy in patients with CDH with catecholamine-resistant refractory hypotension.
Department of Pediatric Surgery, University of Colorado School of Medicine, Aurora, CO. Electronic address: shannon.acker@ucdenver.edu.
Shannon N
SN
Acker
Department of Neonatology, University of Colorado School of Medicine, Aurora, CO.
John P
JP
Kinsella
Department of Pediatric Pulmonary Medicine, University of Colorado School of Medicine, Aurora, CO.
Steven H
SH
Abman
Department of Neonatology, University of Colorado School of Medicine, Aurora, CO.
Jason
J
Gien
D001794:Blood Pressure; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000188:drug therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000188:drug therapy*; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D014667:Vasopressins