title: Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery: The VANCS Randomized Controlled Trial.
abstract: Vasoplegic syndrome is a common complication after cardiac surgery and impacts negatively on patient outcomes. The objective of this study was to evaluate whether vasopressin is superior to norepinephrine in reducing postoperative complications in patients with vasoplegic syndrome.
  
  
  
  This prospective, randomized, double-blind trial was conducted at the Heart Institute, University of Sao Paulo, Sao Paulo, Brazil, between January 2012 and March 2014. Patients with vasoplegic shock (defined as mean arterial pressure less than 65 mmHg resistant to fluid challenge and cardiac index greater than 2.2 l · min · m) after cardiac surgery were randomized to receive vasopressin (0.01 to 0.06 U/min) or norepinephrine (10 to 60 μg/min) to maintain arterial pressure. The primary endpoint was a composite of mortality or severe complications (stroke, requirement for mechanical ventilation for longer than 48 h, deep sternal wound infection, reoperation, or acute renal failure) within 30 days.
  
  
  
  A total of 330 patients were randomized, and 300 were infused with one of the study drugs (vasopressin, 149; norepinephrine, 151). The primary outcome occurred in 32% of the vasopressin patients and in 49% of the norepinephrine patients (unadjusted hazard ratio, 0.55; 95% CI, 0.38 to 0.80; P = 0.0014). Regarding adverse events, the authors found a lower occurrence of atrial fibrillation in the vasopressin group (63.8% vs. 82.1%; P = 0.0004) and no difference between groups in the rates of digital ischemia, mesenteric ischemia, hyponatremia, and myocardial infarction.
  
  
  
  The authors' results suggest that vasopressin can be used as a first-line vasopressor agent in postcardiac surgery vasoplegic shock and improves clinical outcomes.
authors.affiliation: From the Surgical Intensive Care Unit, Department of Cardiopneumology (L.A.H., F.R.B.G.G., E.A.O., R.R.M., M.R.S., S.M.G., R.A.F., R.E.N., J.P.d.A., A.M.G., D.H.S., M.A.G., J.T.F., C.L.P., C.Z., G.S.R.F., F.L.F., L.C., S.Z., V.G.S.P., M.A.P., J.O.C.A.) and Divisions of Cardiovascular Surgery (F.A.G., P.M.P., L.O.D., L.A.L., F.B.J.), Infectious Diseases (T.M.S.), and Cardiology (R.K.F.), Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil; Department of Intensive Care, Erasme University Hospital, Université de Bruxelles, Brussels, Belgium (J.L.V.); Department of Intensive Care Medicine, St George's Healthcare NHS Trust and St George's University of London, London, United Kingdom (A.R.); Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy (G.L.) and Vita-Salute San Raffaele University, Milan, Italy (G.L.).
authors.forename: Ludhmila Abrahao
authors.initials: LA
authors.lastname: Hajjar
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Vincent
authors.forename: Filomena Regina
authors.initials: FR
authors.lastname: Barbosa Gomes Galas
authors.forename: Andrew
authors.initials: A
authors.lastname: Rhodes
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Eduardo Atsushi
authors.initials: EA
authors.lastname: Osawa
authors.forename: Renato Rosa
authors.initials: RR
authors.lastname: Melo
authors.forename: Marcia Rodrigues
authors.initials: MR
authors.lastname: Sundin
authors.forename: Solimar Miranda
authors.initials: SM
authors.lastname: Grande
authors.forename: Fabio A
authors.initials: FA
authors.lastname: Gaiotto
authors.forename: Pablo Maria
authors.initials: PM
authors.lastname: Pomerantzeff
authors.forename: Luis Oliveira
authors.initials: LO
authors.lastname: Dallan
authors.forename: Rafael Alves
authors.initials: RA
authors.lastname: Franco
authors.forename: Rosana Ely
authors.initials: RE
authors.lastname: Nakamura
authors.forename: Luiz Augusto
authors.initials: LA
authors.lastname: Lisboa
authors.forename: Juliano Pinheiro
authors.initials: JP
authors.lastname: de Almeida
authors.forename: Aline Muller
authors.initials: AM
authors.lastname: Gerent
authors.forename: Dayenne Hianae
authors.initials: DH
authors.lastname: Souza
authors.forename: Maria Alice
authors.initials: MA
authors.lastname: Gaiane
authors.forename: Julia Tizue
authors.initials: JT
authors.lastname: Fukushima
authors.forename: Clarice Lee
authors.initials: CL
authors.lastname: Park
authors.forename: Cristiane
authors.initials: C
authors.lastname: Zambolim
authors.forename: Graziela Santos
authors.initials: GS
authors.lastname: Rocha Ferreira
authors.forename: Tânia Mara
authors.initials: TM
authors.lastname: Strabelli
authors.forename: Felipe Lourenco
authors.initials: FL
authors.lastname: Fernandes
authors.forename: Ligia
authors.initials: L
authors.lastname: Camara
authors.forename: Suely
authors.initials: S
authors.lastname: Zeferino
authors.forename: Valter Garcia
authors.initials: VG
authors.lastname: Santos
authors.forename: Marilde Albuquerque
authors.initials: MA
authors.lastname: Piccioni
authors.forename: Fabio Biscegli
authors.initials: FB
authors.lastname: Jatene
authors.forename: Jose Otavio
authors.initials: JO
authors.lastname: Costa Auler
authors.forename: Roberto Kalil
authors.initials: RK
authors.lastname: Filho
mesh_terms: D001938:Brazil; D006348:Cardiac Surgical Procedures; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000494:pharmacology*; D011183:Postoperative Complications / Q000188:drug therapy*; D011446:Prospective Studies; D012769:Shock / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000494:pharmacology; D056987:Vasoplegia / Q000150:complications / Q000188:drug therapy*; D014667:Vasopressins / Q000494:pharmacology*
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins; D009638:Norepinephrine