Arginine-vasopressin in neonates with vasodilatory shock after cardiopulmonary bypass

Abstract

In neonates with vasodilatory shock after cardiopulmonary bypass AVP is a potent agent to increase blood pressure when traditional vasopressors are failing.

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

“…Experience with AVP/TP in neonates has been more focused on term newborns with congenital heart disease who develop hypotension after surgery, newborns with PPHN or with septic shock all reporting increased blood pressure, most reporting increased urine output and some reporting decreased lactate levels coming from retrospective studies or case series [85,[90][91][92][93][94][95].…”

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

“…For both septic [11][12][13][14][15][16][17][18][19][20][21][22] and cardiac shock patients [23][24][25][26][27][28] an increase in blood pressure, and a rise in urine output was noted, although some data suggest that AVP/TP may be more effective in restoring cardiovascular function in children with septic shock with vasoparalysis rather than in children with primary cardiac compromise [34]. Overall, there was a strong tendency for decreased demand in conventional inotropes for both septic and cardiac patients.…”

“…The increase in arterial blood pressure was commonly associated with a drop in heart rate in some reports [16,18,34]. In 8 reports the administration of AVP/TP was associated with an increase in urine output [12,18,24,27,29,35,36,38], in two reports urine output decreased [13,32], while in five reports urine output remained unchanged [11,26,28,31,37]. In the remaining reports, urine output was not an outcome parameter [14-17, 19-23, 25, 30, 33, 34, 39-41].…”

“…Initial serum lactate concentrations were higher in non-survivors (8.3 AE 1.0 mmol/L) than in survivors (3.4 AE 2.2 mmol/L) [27]. Eight out of those eleven reports demonstrated a decrease in serum lactate concentrations most notably for survivors [13,15,18,20,26,27,31,34], while three did not show a decrease in serum lactate [21,30,32].…”

“…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].…”