title: Effect of corticosteroids on arginine vasopressin after pediatric cardiac surgery.
abstract: BACKGROUND
  Arginine vasopressin's (AVP) efficacy in the treatment of refractory hypotension is, in part, dependent upon preinfusion endogenous AVP concentration. Corticosteroids, also commonly used to treat refractory hypotension, have been shown to suppress endogenous AVP release. We aimed to determine if corticosteroids affect endogenous AVP concentrations in children recovering from cardiac surgery.
  
  
  METHODS
  We reviewed the records of children who underwent cardiac surgery between January 2008 and January 2009 and had AVP concentrations available as part of a prior prospective study. Doses of hydrocortisone, methylprednisolone, and dexamethasone administered within the first 48 hours after cardiopulmonary bypass were quantitated. Multivariable linear regression was performed to determine if corticosteroids had a significant effect on 48-hour plasma AVP concentration.
  
  
  RESULTS
  Sixty-nine children with plasma AVP concentrations available were reviewed, 34 (49%) of which received corticosteroids within 48 hours after cardiopulmonary bypass. On multivariable regression, greater number of corticosteroid doses but not cumulative corticosteroid dosage was significantly associated with low 48-hour AVP concentration (β=-4.0; 95% confidence intervals, -6.5 to -1.4).
  
  
  CONCLUSIONS
  Children who receive multiple doses of corticosteroids after cardiac surgery, regardless of potency, are likely to have low endogenous AVP concentrations. Children who remain unstable despite corticosteroids may respond favorably to exogenous AVP therapy.
authors.affiliation: Department of Pediatrics, Division of Critical Care Medicine, Children's Hospital of Michigan, in affiliation with Wayne State University School of Medicine, Detroit, MI 48201. Electronic address: cmastrop@iupui.edu.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Mastropietro
authors.affiliation: Wayne State University School of Medicine, Detroit, MI 48201. Electronic address: kmiletic@med.wayne.edu.
authors.forename: Kyle
authors.initials: K
authors.lastname: Miletic
authors.affiliation: Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48201. Electronic address: hchen@med.wayne.edu.
authors.forename: Haiping
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48201. Electronic address: nrossi@med.wayne.edu.
authors.forename: Noreen F
authors.initials: NF
authors.lastname: Rossi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D001127:Arginine Vasopressin / Q000097:blood* / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002317:Cardiovascular Agents; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D007022:Hypotension / Q000097:blood* / Q000188:drug therapy*; D007223:Infant; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D011446:Prospective Studies; D012044:Regression Analysis; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D002317:Cardiovascular Agents; D005938:Glucocorticoids; D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin; D003907:Dexamethasone; D006854:Hydrocortisone; D008775:Methylprednisolone
keywords: Arginine vasopressin; Cardiac surgical procedures; Cardiopulmonary bypass; Corticosteroids; Hemodynamics; Postoperative care