Effects of Vasopressin Infusion After Pediatric Cardiac Surgery: A Meta-analysis

Farias, Juan; Villarreal, Enrique G.; Flores, Saúl; Mastropietro, Christopher W.; Vogel, Maggie; Schulz, Kelci; Culichia, Corissa N.; Iliopoulos, Ilias; Bronicki, Ronald A.; Loomba, Rohit S.

doi:10.1007/s00246-020-02496-8

Cited by 9 publications

(5 citation statements)

References 17 publications

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“…Similarly, to other parameters this must be interpreted with caution in the setting of being the result of a model with relatively low probability that also explained a minority of the variance in central venous pressure. Similar ndings have been previous demonstrated [40]. This lack of close association between central venous pressure and variables such as uid balance and mean arterial pressure should not necessarily be surprising.…”

Section: So Then What Does Central Venous Pressure Mean Clinically?supporting

confidence: 90%

Factors associated with central venous pressure in children with parallel circulation after the Norwood operation: insights from high resolution hemodynamic data

Loomba,

Farias,

Flores

et al. 2023

Preprint

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Introduction Central venous pressure (CVP) plays a crucial role in guiding clinical management, particularly in critically ill children. However, its applicability in children with parallel circulation after the Norwood operation remains poorly understood. This study aimed to identify clinical factors associated with CVP in mechanically ventilated children with parallel circulation. Methods This retrospective study analyzed data from nine neonates with functionally univentricular hearts who underwent the Norwood operation. Various clinical variables, including hemodynamic parameters, ventilatory data, and medication doses, were collected using the T3 software with high temporal resolution. Bayesian linear regression was employed to model CVP using these variables. Results A total of 27,270 data points from 1,338 patient hours were analyzed. The most probable model explained only 32.4% of the variance in CVP. Variables significantly associated with CVP included fluid balance, milrinone dose, vasopressin dose, peak airway pressure, mean airway pressure, positive end expiratory pressure, fraction of inspired oxygen, temperature, mean arterial pressure, renal near infrared spectroscopy, and systemic vascular resistance. However, the clinical significance of some associations was limited due to the magnitude of change required in independent variables to affect CVP. Conclusion This study demonstrates that modeling CVP in neonates with parallel circulation after the Norwood operation is challenging, and CVP is not strongly associated with routinely monitored variables. Clinicians should interpret CVP cautiously and consider other clinical parameters when assessing fluid balance and circulatory status in these patients. Further research is needed to better understand the factors influencing CVP in this unique population.

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Section: So Then What Does Central Venous Pressure Mean Clinically?supporting

confidence: 90%

Factors associated with central venous pressure in children with parallel circulation after the Norwood operation: insights from high resolution hemodynamic data

Loomba,

Farias,

Flores

et al. 2023

Preprint

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“…Vasopressin acts through receptors in the mesenteric circulations, skeletal muscle, and skin to directly increase SVR (3). However, in studies limited by few patients, retrospective design, and/or confounding variables, prior authors have demonstrated minimal systemic blood pressure response in Fontan patients (9, 10). A placebo-controlled trial of vasopressin infusion immediately following Fontan completion also showed no difference in postoperative blood pressure, but this study was confounded by unconstrained titration of other vasoactive drugs, with significantly higher use of the afterload reducing agent milrinone in the vasopressin arm (11).…”

Section: Discussionmentioning

confidence: 99%

“…In patients with a biventricular circulation and preserved myocardial function, vasopressin has been shown to increase SVR and systolic blood pressure without significantly altering PVR or mean pulmonary artery pressure (7,8). However, prior studies suggest there may be a blunted blood pressure response to vasopressin in Fontan patients (9,10). More recently vasopressin was shown to reduce the transpulmonary gradient immediately following Fontan completion surgery, suggesting that vasopressin either decreased the PVR, the cardiac output, or both (11).…”

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confidence: 99%

Acute Hemodynamics in the Fontan Circulation: Open-Label Study of Vasopressin*

Adamson

Ramamoorthy

et al. 2023

Pediatric Critical Care Medicine

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Objective: To describe the acute hemodynamic effect of vasopressin on the Fontan circulation, including systemic and pulmonary pressures and resistances, left atrial pressure, and cardiac index. Design: Prospective, open-label, nonrandomized study (NCT04463394). Setting: Cardiac catheterization laboratory at Lucile Packard Children’s Hospital, Stanford. Patients: Patients 3–50 years old with a Fontan circulation who were referred to the cardiac catheterization laboratory for hemodynamic assessment and/or intervention. Interventions: A 0.03 U/kg IV (maximum dose 1 unit) bolus of vasopressin was administered over 5 minutes, followed by a maintenance infusion of 0.3 mU/kg/min (maximum dose 0.03 U/min). MEASUREMENTS AND MAIN RESULTS: Comprehensive cardiac catheterization measurements before and after vasopressin administration. Measurements included pulmonary artery, atrial, and systemic arterial pressures, oxygen saturations, and systemic and pulmonary flows and resistances. There were 28 patients studied. Median age was 13.5 (9.1, 17) years, and 16 (57%) patients had a single or dominant right ventricle. Following vasopressin administration, systolic blood pressure and systemic vascular resistance (SVR) increased by 17.5 (13.0, 22.8) mm Hg (Z value −4.6, p < 0.001) and 3.8 (1.8, 7.5) Wood Units (Z value −4.6, p < 0.001), respectively. The pulmonary vascular resistance (PVR) decreased by 0.4 ± 0.4 WU (t statistic 6.2, p < 0.001), and the left atrial pressure increased by 1.0 (0.0, 2.0) mm Hg (Z value −3.5, p < 0.001). The PVR:SVR decreased by 0.04 ± 0.03 (t statistic 8.1, p < 0.001). Neither the pulmonary artery pressure (median difference 0.0 [−1.0, 1.0], Z value −0.4, p = 0.69) nor cardiac index (0.1 ± 0.3, t statistic −1.4, p = 0.18) changed significantly. There were no adverse events. Conclusions: In Fontan patients undergoing cardiac catheterization, vasopressin administration resulted in a significant increase in systolic blood pressure, SVR, and left atrial pressure, decrease in PVR, and no change in cardiac index or pulmonary artery pressure. These findings suggest that in Fontan patients vasopressin may be an option for treating systemic hypotension during sedation or general anesthesia.

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“…In the cardiac intensive care unit (CICU), vasopressin has been initiated in children after cardiac surgery to improve hemodynamics including a decrease in heart rate, inotrope score, central venous pressure, and lactate concentrations as well as an increase in blood pressure. 2,3 In addition to its effect on V1 receptors, vasopressin also stimulates V 2 receptors and leads to decreased free water excretion. 1 As a result of decreased free water excretion, hyponatremia can occur and could be especially problematic in children with congenital heart disease.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vasopressin-Induced Hyponatremia in Infants Following Cardiovascular Surgery

et al. 2022

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Background Vasopressin is increasingly used in infants following cardiac surgery. Hyponatremia is a noted adverse event, but incidence and risk factors remain undefined. Objective The primary objective was to identify the incidence of vasopressin-induced hyponatremia. Secondary objectives included comparing baseline and change in serum sodium concentrations between infants receiving vasopressin with and without hyponatremia, and comparing vasopressin dose, duration, and clinical characteristics in those with and without hyponatremia. Methods This Institutional Review Board–approved, retrospective case-control study included infants <6 months following cardiac surgery receiving vasopressin for ≥6 hours at a tertiary care, academic hospital. Patients who developed hyponatremia, cases, were matched to controls in a 1:2 fashion. Demographics and clinical characteristics were collected. Descriptive and inferential statistics were employed. A conditional logistic regression was used to assess odds of hyponatremia. Results Of the included 142 infants, 20 (14.1%) developed hyponatremia and were matched with 40 controls. There was significant difference in median nadir between controls and cases, 142.0 versus 128.5 mEq/L (<0.001). A significantly higher number of cases received corticosteroids, loop diuretics, and chlorothiazide versus controls. The regression analysis demonstrated that each additional hour of vasopressin increased the odds of developing hyponatremia by 5% (adjusted odds ratio 1.05 [confidence interval 1-1.1]). Conclusions and relevance Vasopressin-induced hyponatremia incidence was <15%. Vasopressin duration was independently associated with hyponatremia development.

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Effects of Vasopressin Infusion After Pediatric Cardiac Surgery: A Meta-analysis

Cited by 9 publications

References 17 publications

Factors associated with central venous pressure in children with parallel circulation after the Norwood operation: insights from high resolution hemodynamic data

Factors associated with central venous pressure in children with parallel circulation after the Norwood operation: insights from high resolution hemodynamic data

Acute Hemodynamics in the Fontan Circulation: Open-Label Study of Vasopressin*

Vasopressin-Induced Hyponatremia in Infants Following Cardiovascular Surgery

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