Risk factors for vasoplegia after cardiac surgery: a meta-analysis

Dayan, Víctor; Cal, Rosana; Giangrossi, Fiorella

doi:10.1093/icvts/ivy352

Cited by 41 publications

(48 citation statements)

References 24 publications

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“…Depending on the definition used, between 5 and 25% of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) will present sustained hypotension after surgery presumably attributed to loss of peripheral vascular resistance [ 1 , 2 ]. This phenomenon is most probably multifactorial [ 3 – 5 ], with inflammatory [ 6 , 7 ] and ischemia–reperfusion [ 8 ] insults at the forefront.…”

Section: Introductionmentioning

confidence: 99%

Potential risks in using midodrine for persistent hypotension after cardiac surgery: a comparative cohort study

Tremblay

Laramée

Lamarche

et al. 2020

Ann. Intensive Care

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Background Persistent hypotension is a frequent complication after cardiac surgery with cardiopulmonary bypass (CPB). Midodrine, an orally administered alpha agonist, could potentially reduce intravenous vasopressor use and accelerate ICU discharge of otherwise stable patients. The main objective of this study was to explore the clinical impacts of administering midodrine in patients with persistent hypotension after CPB. Our hypothesis was that midodrine would safely accelerate ICU discharge and be associated with more days free from ICU at 30 days. Results We performed a retrospective cohort study that included all consecutive patients having received midodrine while being on vasopressor support in the ICU within the first week after cardiac surgery with CPB, between January 2014 and January 2018 at the Montreal Heart Institute. A contemporary propensity score matched control group that included patients who presented similarly prolonged hypotension after cardiac surgery was formed. After matching, 74 pairs of patients (1:1) fulfilled inclusion criteria for the study and control groups. Midodrine use was associated with fewer days free from ICU (25.8 [23.7–27.1] vs 27.2 [25.9–28] days, p = 0.002), higher mortality (10 (13.5%) vs 1 (1.4%), p = 0.036) and longer ICU length of stay (99 [68–146] vs 68 [48–99] hours, p = 0.001). There was no difference in length of intravenous vasopressors (63 [40–87] vs 44 [26–66] hours, p = 0.052), rate of ICU readmission (6 (8.1%) vs 2 (2.7%), p = 0.092) and occurrence of severe kidney injury (11 (14.9%) vs 10 (13.5%) patients, p = 0.462) between groups. Conclusion The administration of midodrine for sustained hypotension after cardiac surgery with CPB was associated with fewer days free from ICU and higher mortality. Routine prescription of midodrine to hasten ICU discharge after cardiac surgery should be used with caution until further prospective studies are conducted.

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Section: Introductionmentioning

confidence: 99%

Potential risks in using midodrine for persistent hypotension after cardiac surgery: a comparative cohort study

Tremblay

Laramée

Lamarche

et al. 2020

Ann. Intensive Care

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“…However, the recent meta-analysis published this year, accumulated the available evidence in the form of a systematic evaluation of the risk factors in interrogation. 5 The pioneer meta-analysis meticulously outlined the risk of VS with the various perioperative factors under evaluation ( Table 1). The range of factors associated with an elevated risk of VS, were consistent with the literature.…”

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confidence: 99%

Vasoplegic syndrome after cardiac surgery: Better the devil you know!

2019

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“…2 The incidence of vasoplegia in cardiac surgery has been reported to be 9% to 40%. 3,4 According to one meta-analysis, most studies used the following criteria to diagnose vasoplegia-mean arterial pressure <50 to 70 mmHg, treatment with at least 1 vasopressor, and a cardiac index of 2.2 to 3.5 L/min/m 2 . 3 This definition differs slightly from the included definition by van Vessem et al, although "inotropes were started if the mean arterial pressure was below 65 mmHg, and adequate end-organ perfusion was maintained" (personnel communication), which in clinical practice suggests that the definitions were similar.…”

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confidence: 99%

“…3,4 According to one meta-analysis, most studies used the following criteria to diagnose vasoplegia-mean arterial pressure <50 to 70 mmHg, treatment with at least 1 vasopressor, and a cardiac index of 2.2 to 3.5 L/min/m 2 . 3 This definition differs slightly from the included definition by van Vessem et al, although "inotropes were started if the mean arterial pressure was below 65 mmHg, and adequate end-organ perfusion was maintained" (personnel communication), which in clinical practice suggests that the definitions were similar. The possible mechanisms of vasoplegia include the depletion of endogenous vasopressin, overproduction of nitric oxide, peripheral resistance to corticosteroids, insufficiency of corticosteroids, catecholamine resistance, inhibition of potassium channels, and subsequent vascular dysfunction.…”

mentioning

confidence: 99%

“…A meta-analysis conducted by Dayan et al 3 demonstrated that factors such as preoperative renal failure, history of previous cardiac surgery, aortic cross-clamp time, cardiopulmonary bypass time, combined procedures, and intraoperative transfusion are associated with an increased incidence of vasoplegia. van Vessem et al 9 showed in their retrospective study that the 90-day survival rate was lower in patients who had vasoplegia compared with those who did not have vasoplegia.…”

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confidence: 99%

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