Relative deficiency of arginine vasopressin in children after cardiopulmonary bypass*

Abstract

In some children undergoing open heart surgery, plasma arginine vasopressin concentration is relatively low at baseline and remains low after cardiopulmonary bypass regardless of hemodynamic stability and serum osmolality. These children are likely the optimal candidates for exogenous arginine vasopressin should hemodynamic compromise occur.

The role of vasopressin and terlipressin in catecholamine-resistant shock and cardio-circulatory arrest in children: Review of the literature

“…1). Only 6 reports were done prospectively [11,14,23,31,34,39], while 13 were retrospective reports [12, 18, 24-29, 32, 35, 36, 40, 41]. In the remaining 12 reports the nature of the study was not clarified.…”

“…These two reports showed a depletion of endogenous AVP levels, and a rise in AVP levels following exogenous AVP administration [31,36]. One prospective observational study measured changes in AVP concentration in more detail in 120 children before and after cardiopulmonary bypass (CPB) surgery [23]. Mean plasma AVP (pg/mL) for all patients was 21 AE 63 before CPB and 80 AE 145, 43 AE 79, and 19 AE 25 at 4, 24, and 48 h after CPB.…”

“…Only three reports measured endogenous AVP levels in all patients before starting AVP [23,31,36]. These two reports showed a depletion of endogenous AVP levels, and a rise in AVP levels following exogenous AVP administration [31,36].…”

“…The age ranged from extremely low birthweight infants [29,34] up to a 19-year-old patient. Sixteen articles were descriptive case series [14, 17, 18, 22, 24, 26-29, 34-38, 40, 41], 10 reports were case reports [12, 13, 15, 16, 19-21, 25, 30, 33], three were clinical evaluation studies [23,32,39], one study was a non-blind randomised control trial [11] and one was a multicentre double-blind randomised control trial [31]. Eighteen reports used AVP while thirteen did TP (Tab.…”

“…In most reports, AVP and TP were exclusively used as a rescue therapy in severe forms of septic, cardiogenic, anaphylactic and hypotensive shock that was not responsive to catecholamines. Twelve reports were confined solely to septic patients [11][12][13][14][15][16][17][18][19][20][21][22], 6 reports were solely on patients with low cardiac output and/or concomitant severe vasodilation following cardiac surgery in some patients [23][24][25][26][27][28], 10 included a heterogenous population (septic shock, cardio-circulatory failure secondary to congenital heart disease, haemorrhagic and anaphylactic) [29][30][31][32][33][34][35][36][37][38] (for more details regarding septic vs. cardiac shock please see below). TP and AVP were used for cardiopulmonary resuscitation in three articles [39][40][41].…”