title: Vasopressin as Therapy During Nonocclusive Mesenteric Ischemia.
abstract: BACKGROUND
  Vasopressin is used as an adjunct to norepinephrine to support blood pressure in vasodilatory shock after cardiopulmonary bypass (CPB). In this study, we report our observation of vasopressin treatment in 11 patients with nonocclusive mesenteric ischemia (NOMI).
  
  
  METHODS
  In an observational cohort study, 78 patients were studied after having been treated for NOMI with intraarterial iloprost infusion after elective cardiac operation. All patients received norepinephrine as vasopressor for marked vasodilation. In 11 patients mean arterial pressure could not be maintained with norepinephrine alone (≤0.4 μg · kg(-1) · min(-1)), and vasopressin was given in addition to norepinephrine as a rescue therapy. The 11 patients (Vaso) and the remaining 67 patients (Nor) were analyzed for clinical improvement after initiation of NOMI treatment, on the following days 1 and 2, and for hospital survival. Intestinal perfusion was controlled by mesenteric angiography.
  
  
  RESULTS
  Before initiation of NOMI treatment Vaso patients had significantly higher doses of norepinephrine than the Nor patients (Vaso, 0.65 ± 0.20 μg · kg(-1) · min(-1); Nor, 0.20 ± 0.13 μg · kg(-1) · min(-1); p < 0.001), and their diagnostic score of the angiography was higher (Vaso, 5.4 ± 1.1 points; Nor, 3.5 ± 2.1 points; p = 0.004). After 2 days of NOMI treatment, Vaso patients had improved intestinal perfusion in the control angiography (Vaso, 3.8 ± 1.5 points) and significantly lower doses of norepinephrine than the Nor patients (Vaso, 0.28 ± 0.12 μg · kg(-1) · min(-1); Nor, 0.53 ± 0.34 μg · kg(-1) · min(-1); p = 0.002). All patients survived in the Vaso group; in the Nor group, 17 of 67 patients died in the hospital.
  
  
  CONCLUSIONS
  Vasopressin administration during NOMI treatment after CPB seems to improve small intestine perfusion and appears be to associated with improved hospital survival.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany; Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Bomberg
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Heinrich V
authors.initials: HV
authors.lastname: Groesdonk
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Raffel
authors.affiliation: Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Minko
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Schmied
authors.affiliation: Department of Medicine, Division of Nephrology and Hypertension, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Klingele
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany. Electronic address: h-j.schaefers@uks.eu.
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D008297:Male; D065666:Mesenteric Ischemia / Q000188:drug therapy*; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use*
chemical_list: D014667:Vasopressins; D009638:Norepinephrine