title: Arginine-vasopressin therapy in hypotensive neonates and infants after cardiac surgery: response is unrelated to baseline ventricular function.
abstract: We hypothesised that infants with ventricular dysfunction after cardiac surgery have impaired haemodynamic response to arginine-vasopressin therapy. We retrospectively reviewed the medical records of neonates and infants treated with arginine-vasopressin within 48 hours of corrective or palliative cardiac surgery who underwent echocardiographic assessment of ventricular function before initiation of therapy. Patients were classified as "responders" if their systolic blood pressure increased by ⩾10% without increase in catecholamine score or if it was maintained with decreased catecholamine score. Response was assessed 1 hour after maximum upward titration of arginine-vasopressin. A total of 36 children (15 neonates) were reviewed (17 male). The median (interquartile) age was 10.4 weeks (1.1-26.9), and the median weight was 4.3 kg (3.2-5.8). Diagnoses included single ventricle (eight), arch abnormalities (five), atrioventricular septal defect (four), double-outlet right ventricle (three), tetralogy of Fallot (three), and others (13). In all, 12 patients (33%) had ventricular dysfunction. Only 15 (42%) responded favourably according to our definition 1 hour after the "target" arginine-vasopressin dose was achieved. Ventricular dysfunction was not associated with poor response. The overall mortality was 25%, but mortality in patients with ventricular dysfunction was 42%. Favourable response was associated with shorter ICU stay (9.5 days versus 19.5 days, p=0.01). We conclude that arginine-vasopressin fails to increase blood pressure in ~50% of hypotensive children after cardiac surgery. The response rate does not increase with duration of therapy. Ventricular function does not predict haemodynamic response. The mortality in this group is very high. Prospective comparison of vasopressin with other vasoactive agents and/or inotropes is warranted.
authors.affiliation: 1Cardiac Intensive Care Unit,Cincinnati Children's Hospital Medical Center,Heart Institute,Cincinnati,Ohio,United States of America.
authors.forename: Ilias
authors.initials: I
authors.lastname: Iliopoulos
authors.affiliation: 1Cardiac Intensive Care Unit,Cincinnati Children's Hospital Medical Center,Heart Institute,Cincinnati,Ohio,United States of America.
authors.forename: Saul
authors.initials: S
authors.lastname: Flores
authors.affiliation: 1Cardiac Intensive Care Unit,Cincinnati Children's Hospital Medical Center,Heart Institute,Cincinnati,Ohio,United States of America.
authors.forename: J N
authors.initials: JN
authors.lastname: Pratap
authors.affiliation: 1Cardiac Intensive Care Unit,Cincinnati Children's Hospital Medical Center,Heart Institute,Cincinnati,Ohio,United States of America.
authors.forename: David S
authors.initials: DS
authors.lastname: Cooper
authors.affiliation: 2Heart Institute Research Core,Cincinnati Children's Hospital Medical Center,Heart Institute,Cincinnati,Ohio,United States of America.
authors.forename: Amy
authors.initials: A
authors.lastname: Cassedy
authors.affiliation: 1Cardiac Intensive Care Unit,Cincinnati Children's Hospital Medical Center,Heart Institute,Cincinnati,Ohio,United States of America.
authors.forename: David P
authors.initials: DP
authors.lastname: Nelson
mesh_terms: D001127:Arginine Vasopressin / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D018754:Ventricular Dysfunction / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016276:Ventricular Function / Q000502:physiology*
chemical_list: D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin
keywords: Arginine–vasopressin; CHD; cardiac surgery; cardiopulmonary bypass; hypotension; ventricular dysfunction