Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-24T14:01:20.707Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical response to arginine vasopressin therapy after paediatric cardiac surgery

Published online by Cambridge University Press:  18 July 2012

Christopher W. Mastropietro ,
Maria C. Davalos ,
Shivaprakash Seshadri ,
Henry L. Walters III  and
Ralph E. Delius
Christopher W. Mastropietro*
Affiliation:
Division of Critical Care, Department of Pediatrics, Wayne State University/Children's Hospital of Michigan, Detroit, Michigan, United States of America
Maria C. Davalos
Affiliation:
Department of Pediatrics, Wayne State University/Children's Hospital of Michigan, Detroit, Michigan, United States of America
Shivaprakash Seshadri
Affiliation:
Department of Cardiovascular Surgery, Wayne State University/Children's Hospital of Michigan, Detroit, Michigan, United States of America
Henry L. Walters III
Affiliation:
Department of Cardiovascular Surgery, Wayne State University/Children's Hospital of Michigan, Detroit, Michigan, United States of America
Ralph E. Delius
Affiliation:
Department of Cardiovascular Surgery, Wayne State University/Children's Hospital of Michigan, Detroit, Michigan, United States of America
*
Correspondence to: Dr C. W. Mastropietro, MD, Department of Pediatrics, Children's Hospital of Michigan, Carl's Building, 4th floor, 3901 Beaubien Street, Detroit, Michigan 48201, United States of America. Tel: 313 745 7495; Fax: 313 966 0105; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To describe the haemodynamic response of children who receive arginine vasopressin for haemodynamic instability after cardiac surgery and to identify clinical variables associated with a favourable response.

Materials and Methods

We reviewed patients less than or equal to 6 years undergoing open heart surgery in our institution between January, 2009 and July, 2010 who received arginine vasopressin during the first 7 days post operation. Favourable responders were defined as those in whom blood pressure was increased or maintained and catecholamine score was decreased, or blood pressure was increased by greater than or equal to 10% of baseline and catecholamine score was unchanged at 6 hours following arginine vasopressin initiation.

Results

Of the 34 patients identified, 17 (50%) patients responded favourably to arginine vasopressin. At 6 hours, the mean blood pressure was increased by 32.2% in responders as compared with 4.6% in non-responders, with a p-value less than 0.001. The mean catecholamine score decreased by 30.1% in responders and increased by 7.6% in non-responders, with a p-value less than 0.001. Anthropometric, demographic, and intra-operative variables were similar in both groups, as was maximum dose of arginine vasopressin. The median time after arrival to the intensive care unit at which arginine vasopressin was initiated, however, was later in those who responded, 20 hours as compared with those who did not, 6 hours, with a p-value equal to 0.032.

Conclusions

Arginine vasopressin therapy led to haemodynamic improvement in only half of the children in this study, and improvement was more likely to occur if arginine vasopressin was initiated after the post-operative night.

Keywords

Cardiac surgical procedurescardiopulmonary bypasspost-operative care
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 3 , June 2013 , pp. 387 - 393
Copyright
Copyright © Cambridge University Press 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Rosenzweig, EB, Starc, TJ, Chen, JM, et al. Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. Circulation 1999; 100: II-182–II-186.CrossRefGoogle ScholarPubMed
2. Lechner, E, Hofer, A, Mair, R, Moosbauer, W, Sames-Dolzer, E, Tulzer, G. Arginine-vasopressin in neonates with vasodilatory shock after cardiopulmonary bypass. Eur J Pediatr 2007; 166: 1221–1227.CrossRefGoogle ScholarPubMed
3. Jerath, N, Frndova, H, McCrindle, BW, Gurofsky, R, Humpl, T. Clinical impact of vasopressin infusion on hemodynamics, liver and renal function in pediatric patients. Intensive Care Med 2008; 34: 1274–1280.CrossRefGoogle ScholarPubMed
4. Mastropietro, CW, Clark, JA, Delius, RE, Walters, HL 3rd, Sarnaik, AP. Arginine vasopressin to manage hypoxemic infants after stage I palliation of single ventricle lesions. Pediatr Crit Care Med 2008; 9: 506–510.Google Scholar
5. Mastropietro, CW, Rossi, NF, Clark, JA, et al. Relative deficiency in arginine vasopressin in children after cardiopulmonary bypass. Crit Care Med 2010; 38: 2052–2058.Google Scholar
6. Morrison, WE, Simone, S, Conway, D, Tumulty, J, Johnson, C, Cardarelli, M. Levels of vasopressin in children undergoing cardiopulmonary bypass. Cardiol Young 2008; 18: 135–140.Google Scholar
7. Lacour-Gayet, F, Jacobs, JP, Clarke, DR, et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911–924.CrossRefGoogle Scholar
8. Wernovsky, G, Wypij, D, Jonas, RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995; 92: 2226–2235.CrossRefGoogle ScholarPubMed
9. Killinger, JS, Hsu, DT, Schleien, CL, Mosca, RS, Hardart, GE. Children undergoing heart transplant are at increased risk for postoperative vasodilatory shock. Pediatr Crit Care Med 2009; 10: 335–340.CrossRefGoogle ScholarPubMed
10. Tibby, SM, Hatherhill, M, Murdoch, IA. Capillary refill and core-peripheral temperature gap as indicators of haemodynamic status in paediatric intensive care patients. Arch Dis Child 1999; 80: 163–166.Google Scholar
11. Scheurer, MA, Thiagarajan, RR. Vasoactive-inotropic score as a measure of pediatric cardiac surgical outcomes. Pediatr Crit Care Med 2010; 11: 307–308.CrossRefGoogle ScholarPubMed
12. Holmes, CL, Landry, DW, Granton, JT. Science review: vasopressin and the cardiovascular system part 2 – clinical physiology. Crit Care 2004; 8: 15–23.CrossRefGoogle ScholarPubMed
13. Choong, K, Kissoon, N. Vasopressin in pediatric septic shock and cardiac arrest. Pediatr Crit Care Med 2008; 9: 372–379.Google Scholar