Vasopressin Versus Norepinephrine in Patients With Vasoplegic Shock After Cardiac Surgery

Hajjar, L; Vincent, Jean‐Louis; Galas, F; Rhodes, A; Landoni, Giovanni; Osawa, E; Melo, Renato Rosa; Sundin, M; Grande, Sophie; Gaiotto, Fábio Antônio; Pomerantzeff, Pablo Maria Alberto; Dallan, Luís Alberto de Oliveira; Franco, Rafael Alves; Nakamura, R; Lisboa, Luiz Augusto Ferreira; Almeida, J; Gerent, A; Souza, de; Gaiane, Maria Alice; Fukushima, Júlia Tizue; Park, C. L.; Zambolim, Cristiane Maciel; Ferreira, Gerson Moura; Strabelli, Tânia Mara Varejão; Fernandes, Fernando Antônio da Silva; Câmara, Lígia; Santos, V. Gómez Dos; Piccioni, Marilde de Albuquerque; Jatene, FB; Auler, J; Filho, R. Kalil

doi:10.1097/sa.0000000000000317

Cited by 6 publications

(7 citation statements)

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“…Morbidity includes inotropic-vasopressor usage, length of stay, blood transfusion, arrhythmia risks, renal failure, low cardiac output syndrome, and Durante-operative bleeding. This study recorded demographic and clinical data, as well as the information needed to calculate the predicted risk of surgery using the additive European System for Cardiac Operative Risk Evaluation (7). Moreover, incomplete medical records are excluded.…”

Section: Methodsmentioning

confidence: 99%

EuroSCORE II as Predictor of Mortality and Morbidity in Post-CABG Patient in Dr. Soetomo General Academic Hospital

Rianda

Semedi

Subagjo

et al. 2022

IJAR

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Introduction: European System for Cardiac Operative Risk Evaluation (EuroSCORE) is a scoring system to predict mortality risk after cardiac surgery. EuroSCORE II was introduced to replace and show superiority over EuroSCORE I which tends to overestimate the risk of heart surgery procedures and have a low discrimination ability. Meanwhile, this is the first study to analyze EuroSCORE II as a predictor of mortality and morbidity in Indonesians. Objective: This study aims to analyze EuroSCORE II as a predictor of mortality and morbidity in Indonesians. Materials and Methods: This is a retrospective study using medical records of CABG patients in Dr. Soetomo General Academic Hospital from January 2016 to December 2017. Results and Discussion: Out of 39 Patients who have performed CABG surgery, most were male (89.7%) with the highest age range of 46-65 years (59%). Deceased patients had an average EuroSCORE II of 22.36% and SD±26.97%7%, while 27 patients who survived had an average EuroSCORE II of 6.78% and SD±6.4%. Based on morbidity assessment, EuroSCORE II only accurately predicted the risk of kidney failure and did not properly assess the length of inotropic use, vasopressors, hospitalization time, the risk of arrhythmias, low cardiac output syndrome, Durante-operative bleeding, and the need for blood transfusion. These inaccuracies occurred because the samples that were included varied based on their standard deviation and pattern-less graph. Conclusion: EuroSCORE II is inadequate to predict morbidity and mortality in postoperative patients, therefore, it is considered less effective.

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Section: Methodsmentioning

confidence: 99%

EuroSCORE II as Predictor of Mortality and Morbidity in Post-CABG Patient in Dr. Soetomo General Academic Hospital

Rianda

Semedi

Subagjo

et al. 2022

IJAR

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“…At this time, there is no established first-line vasopressor for vasoplegia following CPB. 12,[23][24][25][26][27] Sympathomimetic agents, such as norepinephrine, epinephrine, and phenylephrine, are commonly used. Norepinephrine is an alpha-1 and beta-1 adrenergic receptor agonist.…”

Section: Vasopressorsmentioning

confidence: 99%

“…As discussed above, post-CPB patients may have low serum vasopressin levels, and therefore, vasopressin may be used with some success in the treatment of post-CPB vasoplegia. 12,25,27 However, it may also have unwanted side effects at higher doses, including renal and gastrointestinal malperfusion. [32][33][34] Angiotensin II is a new vasopressor used for the treatment of vasodilatory shock.…”

Section: Vasopressorsmentioning

confidence: 99%

“…11 In addition, vasopressin also modulates K ATP channels, blunting the NO-induced increase in cGMP 5 and enhancing the vascular response to catecholamines. 12 Another pathophysiologic mediator of vasoplegia is hydrogen sulfide (H 2 S), a by-product of the vitamin B6-dependent pathway of homocysteine metabolism. At high concentrations, such as in inflammatory states, H 2 S directly activates and hyperpolarizes K ATP channels, therefore reducing the vascular tone.…”

Section: Introductionmentioning

confidence: 99%

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Vasoplegia after cardiopulmonary bypass: A narrative review of pathophysiology and emerging targeted therapies

2020

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Cardiovascular disease remains the leading cause of death in the United States, and cardiopulmonary bypass is a cornerstone in the surgical management of many related disease states. Pathophysiologic changes associated both with extracorporeal circulation and shock can beget a syndrome of low systemic vascular resistance paired with relatively preserved cardiac output, termed vasoplegia. While increased vasopressor requirements accompany vasoplegia, related pathophysiologic mechanisms may also lead to true catecholamine resistance, which is associated with further heightened mortality. The introduction of a second non-catecholamine vasopressor, angiotensin II, and non-specific nitric oxide scavengers offers potential means by which to manage this challenging phenomenon. This narrative review addresses both the definition, risk factors, and pathophysiology of vasoplegia and potential therapeutic interventions.

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“…Recently published randomized, prospective, and doubleblinded clinical trial compared norepinephrine infusion (n = 151) with vasopressin infusion (n = 149) for the treatment of vasoplegic shock after cardiac surgery. 59 Postoperative complications (stroke, respiratory failure, sternal wound infection, and renal failure) occurred in 49% of patients in the norepinephrine group and 32% in the vasopressin group. The incidence of atrial fibrillation was significantly less in the vasopressin group.…”

Section: Choice Of Vasopressormentioning

confidence: 96%

Noteworthy Literature Published in 2016 for Thoracic Organ Transplantation Anesthesiologists

Subramaniam

Nazarnia

2017

Semin Cardiothorac Vasc Anesth

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This article is first in the series to review the published literature on perioperative issues in patients undergoing thoracic solid organ transplantations. We present recent literature from 2016 on preoperative considerations, organ preservation, intraoperative anesthesia management, surgical techniques, postoperative complications, and the impact of perioperative management on short- and long-term outcomes that are pertinent to thoracic transplantation anesthesiologists.

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Vasopressin Versus Norepinephrine in Patients With Vasoplegic Shock After Cardiac Surgery

Cited by 6 publications

References 0 publications

EuroSCORE II as Predictor of Mortality and Morbidity in Post-CABG Patient in Dr. Soetomo General Academic Hospital

EuroSCORE II as Predictor of Mortality and Morbidity in Post-CABG Patient in Dr. Soetomo General Academic Hospital

Vasoplegia after cardiopulmonary bypass: A narrative review of pathophysiology and emerging targeted therapies

Noteworthy Literature Published in 2016 for Thoracic Organ Transplantation Anesthesiologists

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