BACKGROUND: Vasodilatory shock requiring catecholamine pressors occurs in some patients following cardiopulmonary bypass. Prompted by a clinical observation, we investigated the use of vasopressin as a treatment for this syndrome in a randomized, controlled trial. METHODS AND RESULTS:Patients undergoing placement of a left ventricular assist device (n=23) were evaluated for post-bypass vasodilatory shock requiring catecholamine pressors, and consecutive eligible subjects (n=10) were evenly randomized to blinded intravenous vasopressin or saline placebo. Vasopressin (0.1 U/min) increased mean arterial pressure (57+/-4 to 84+/-2 mm Hg, P<.001) and systemic vascular resistance (813+/-113 to 1188+/-87 dyne-s/cm5, P<.001), with decreased norepinephrine administration. There was no significant response to saline, but in three subjects who crossed over, blinded vasopressin increased mean arterial pressure (69+/-8 to 93+/-4 mm Hg) and systemic vascular resistance (898+/-88 to 1443+/-72 dyne-s/cm5) with decreased norepinephrine administration. Plasma vasopressin concentrations prior to randomization clustered in two groups: one (n=5) with concentrations inappropriately low for the degree of hypotension (8.4+/-2.1 pg/mL) and a second (n=3) with moderately elevated levels (33.7+/-1.6 pg/mL); vasopressin increased mean arterial pressure in the low vasopressin group from 57+/-4 to 85+/-2 mm Hg (P<.01) and in the high vasopressin group from 68+/-8 to 86+/-4 mm Hg. CONCLUSIONS:Vasopressin is an effective pressor in vasodilatory shock after cardiopulmonary bypass. An absolute vasopressin deficiency was observed in the majority of patients, but all subjects responded to vasopressin administration.
RCT Entities:
BACKGROUND: Vasodilatory shock requiring catecholamine pressors occurs in some patients following cardiopulmonary bypass. Prompted by a clinical observation, we investigated the use of vasopressin as a treatment for this syndrome in a randomized, controlled trial. METHODS AND RESULTS:Patients undergoing placement of a left ventricular assist device (n=23) were evaluated for post-bypass vasodilatory shock requiring catecholamine pressors, and consecutive eligible subjects (n=10) were evenly randomized to blinded intravenous vasopressin or saline placebo. Vasopressin (0.1 U/min) increased mean arterial pressure (57+/-4 to 84+/-2 mm Hg, P<.001) and systemic vascular resistance (813+/-113 to 1188+/-87 dyne-s/cm5, P<.001), with decreased norepinephrine administration. There was no significant response to saline, but in three subjects who crossed over, blinded vasopressin increased mean arterial pressure (69+/-8 to 93+/-4 mm Hg) and systemic vascular resistance (898+/-88 to 1443+/-72 dyne-s/cm5) with decreased norepinephrine administration. Plasma vasopressin concentrations prior to randomization clustered in two groups: one (n=5) with concentrations inappropriately low for the degree of hypotension (8.4+/-2.1 pg/mL) and a second (n=3) with moderately elevated levels (33.7+/-1.6 pg/mL); vasopressin increased mean arterial pressure in the low vasopressin group from 57+/-4 to 85+/-2 mm Hg (P<.01) and in the high vasopressin group from 68+/-8 to 86+/-4 mm Hg. CONCLUSIONS:Vasopressin is an effective pressor in vasodilatory shock after cardiopulmonary bypass. An absolute vasopressin deficiency was observed in the majority of patients, but all subjects responded to vasopressin administration.
Authors: Santanu Guha; S Harikrishnan; Saumitra Ray; Rishi Sethi; S Ramakrishnan; Suvro Banerjee; V K Bahl; K C Goswami; Amal Kumar Banerjee; S Shanmugasundaram; P G Kerkar; Sandeep Seth; Rakesh Yadav; Aditya Kapoor; Ajaykumar U Mahajan; P P Mohanan; Sundeep Mishra; P K Deb; C Narasimhan; A K Pancholia; Ajay Sinha; Akshyaya Pradhan; R Alagesan; Ambuj Roy; Amit Vora; Anita Saxena; Arup Dasbiswas; B C Srinivas; B P Chattopadhyay; B P Singh; J Balachandar; K R Balakrishnan; Brian Pinto; C N Manjunath; Charan P Lanjewar; Dharmendra Jain; Dipak Sarma; G Justin Paul; Geevar A Zachariah; H K Chopra; I B Vijayalakshmi; J A Tharakan; J J Dalal; J P S Sawhney; Jayanta Saha; Johann Christopher; K K Talwar; K Sarat Chandra; K Venugopal; Kajal Ganguly; M S Hiremath; Milind Hot; Mrinal Kanti Das; Neil Bardolui; Niteen V Deshpande; O P Yadava; Prashant Bhardwaj; Pravesh Vishwakarma; Rajeeve Kumar Rajput; Rakesh Gupta; S Somasundaram; S N Routray; S S Iyengar; G Sanjay; Satyendra Tewari; Sengottuvelu G; Soumitra Kumar; Soura Mookerjee; Tiny Nair; Trinath Mishra; U C Samal; U Kaul; V K Chopra; V S Narain; Vimal Raj; Yash Lokhandwala Journal: Indian Heart J Date: 2018-06-08
Authors: Stefan Jochberger; Corinna Velik-Salchner; Viktoria D Mayr; Günter Luckner; Volker Wenzel; Gerda Falkensammer; Hanno Ulmer; Nils Morgenthaler; Walter Hasibeder; Martin W Dünser Journal: Intensive Care Med Date: 2008-09-30 Impact factor: 17.440
Authors: J Dave Barry; Dave Durkovich; Lee Cantrell; William Richardson; Tri Tong; Steve Offerman; Richard F Clark; David A Tanen; Saralyn Williams Journal: J Med Toxicol Date: 2005-12