Vasopressin Aggravates Cardiopulmonary Bypass-Induced Gastric Mucosal Ischemia

Bomberg, Hagen; Bierbach, Benjamin; Flache, Stephan; Novák, Matous; Bandner-Risch, Doris; Menger, Michael D.; Schäfers, Hans‐Joachim

doi:10.1159/000368355

Cited by 10 publications

(7 citation statements)

References 35 publications

(53 reference statements)

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“…In addition porcine models show that gastric blood flow is decreased with cardiopulmonary bypass. These effects were exacerbated by the addition of AVP . Porcine models showed similar results in the rectosigmoidal mucosa with decreased microvascular blood flow .…”

Section: Methodsmentioning

confidence: 65%

“…These effects were exacerbated by the addition of AVP. 40 Porcine models showed similar FIGURE 4 Summary of findings of AVP versus placebo or catecholamines in adult CV patients that studied hemodynamics. AKI, acute kidney injury; AVP, arginine vasopressin; CABG, coronary artery bypass grafts; CI, cardiac index; CO, cardiac output; CPB, cardiopulmonary bypass; CVP, central venous pressure; LOS, length of stay; LVAD, left ventricular assist device; MAP, mean arterial pressure; MI, myocardial infraction; NE, norepinephrine; OHT, orthotopic heart transplant, PAP, pulmonary artery pressure; PCWP, pulmonary capillary wedge pressure; PVR, pulmonary vascular resistance; SV, stroke volume; SVR, systemic vascular resistance; UOP, urine output results in the rectosigmoidal mucosa with decreased microvascular blood flow.…”

Section: Adverse Effectsmentioning

confidence: 88%

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Vasopressin therapy in cardiac surgery

et al. 2018

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Background Arginine vasopressin (AVP) is a naturally occurring peptide with diverse effects mediated through selective V1 and V2 receptors. About 10% of patients undergoing cardiopulmonary bypass develop postoperative vasodilatory shock requiring high‐dose catecholamines. We sought to examine the role of AVP therapy in cardiac surgery. Methods A search of Medline was conducted through September 2018 using key words and medical subject headings (MeSH) relating to AVP, copeptin, and cardiac surgery. A systematic review was performed on articles as they pertained to AVP for use as a vasopressor after cardiovascular surgery complicated by vasodilatory shock. Results A relative or absolute deficiency of Arginine vasopressin is associated with vasodilatory shock after cardiopulmonary bypass. Physiologic replacement with exogenous Arginine vasopressin results in significant increases in systemic vascular resistance and mean arterial pressure with decreased requirements of catecholamines. At doses of <0.1 U/min Arginine vasopressin is safe with very few adverse effects. Conclusion Post‐cardiopulmonary bypass vasodilatory shock is largely due to a relative deficiency of Arginine vasopressin. Exogenous administration of low‐dose Arginine vasopressin alone or in combination with traditional catecholamines is a safe and effective way to manage this type of vasodilatory shock.

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Section: Methodsmentioning

confidence: 65%

Section: Adverse Effectsmentioning

confidence: 88%

Vasopressin therapy in cardiac surgery

et al. 2018

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“…Vasopressin has a wide range of dose-dependent physiologic effects on the cardiovascular system, arguably by increasing vascular tone and improving inotropy. Moreover, it does so without directly increasing myocardial oxygen demand or heart rate, although changes in those parameters may be indirectly induced (3,5,6,(8)(9)(10)(11)(12)(13)(14). The virtues of the drug are not merely restricted to the effects on the vasculature.…”

Section: Discussionmentioning

confidence: 99%

“…Reasons for avoiding enteral feeding may relate to the severity of the patient's baseline clinical condition rather than to the use of AVP, especially as most AVP users felt AVP was a second-line medication. Porcine models have shown a decrease in blood flow in the gastric mucosa after cardiopulmonary bypass, exacerbated by the use of AVP ( 9 , 22 ), which could pose a theoretical risk of necrotizing enterocolitis. However, Alten et al reported no cases of necrotizing enterocolitis and adequate tolerance of enteral feeds in all patients with early initiation of AVP after cardiovascular bypass surgery ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

International Survey on the Use of Arginine Vasopressin in the Postoperative Management of Single Ventricle Patients

et al. 2021

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Management of patients with single ventricle physiology after surgical palliation is challenging. Arginine vasopressin has gained popularity in recent years as a non-catecholamine vasoactive medication due to its unique properties. However, data regarding its use in the pediatric population is limited. Therefore, we designed a survey to explore whether and how clinicians use this medication in intensive care units for the postoperative management of single ventricle patients. This international survey aimed to assess usage, practices, and concepts related to arginine vasopressin in pediatric intensive care units worldwide. Directors of pediatric intensive care units who are members of the following international professional societies: European Society of Pediatric Neonatal Intensive Care, Association for European Pediatric and Congenital Cardiology, and Pediatric Cardiac Intensive Care Society were invited to participate in this survey. Of the 62 intensive care unit directors who responded, nearly half use arginine vasopressin in the postoperative management of neonatal single ventricle patients, and 90% also use the drug in subsequent surgical palliation. The primary indications are vasoplegia, hemodynamic instability, and refractory shock, although it is still considered a second-line medication. Conceptual benefits include improved hemodynamics and end-organ perfusion and decreased incidence of low cardiac output syndrome. Those practitioners who do not use arginine vasopressin cite lack of availability, fear of potential adverse effects, unclear indication for use, and lack of evidence suggesting improved outcomes. Both users and non-users described increased myocardial afterload and extreme vasoconstriction as potential disadvantages of the medication. Despite the lack of conclusive data demonstrating enhanced clinical outcomes, our study found arginine vasopressin is used widely in the care of infants and children with single ventricle physiology after the first stage and subsequent palliative surgeries. While many intensive care units use this medication, few had protocols, offering an area for further growth and development.

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“…However, the study cohort was relatively small and further investigations are necessary to verify these findings. The same investigators found vasopressin to reduce blood flow in the superior mesenteric artery and in the rectosigmoidal mucosa, and adversatively improved distal jejunal microvascular blood flow, which underlines the ambiguity of the vasopressors’ effects [22]. …”

Section: Commentmentioning

confidence: 99%

Ischemic Colitis after Cardiac Surgery: Can We Foresee the Threat?

et al. 2016

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IntroductionIschemic colitis (IC) remains a great threat after cardiac surgery with use of extracorporeal circulation. We aimed to identify predictive risk factors and influence of early catecholamine therapy for this disease.MethodsWe prospectively collected and analyzed data of 224 patients, who underwent laparotomy due to IC after initial cardiac surgery with use of extracorporeal circulation during 2002 and 2014. For further comparability 58 patients were identified, who underwent bypass surgery, aortic valve replacement or combination of both. Age ±5 years, sex, BMI ± 5, left ventricular function, peripheral arterial disease, diabetes and urgency status were used for match-pair analysis (1:1) to compare outcome and detect predictive risk factors. Highest catecholamine doses during 1 POD were compared for possible predictive potential.ResultsPatients’ baseline characteristics showed no significant differences. In-hospital mortality of the IC group with a mean age of 71 years (14% female) was significantly higher than the control group with a mean age of 70 (14% female) (67% vs. 16%, p<0.001). Despite significantly longer bypass time in the IC group (133 ± 68 vs. 101 ± 42, p = 0.003), cross-clamp time remained comparable (64 ± 33 vs. 56 ± 25 p = 0.150). The majority of the IC group suffered low-output syndrome (71% vs. 14%, p<0.001) leading to significant higher lactate values within first 24h after operation (55 ± 46 mg/dl vs. 31 ± 30 mg/dl, p = 0.002). Logistic regression revealed elevated lactate values to be significant predictor for colectomy during the postoperative course (HR 1.008, CI 95% 1.003–1.014, p = 0.003). However, Receiver Operating Characteristic Curve calculates a cut-off value for lactate of 22.5 mg/dl (sensitivity 73% and specificity 57%). Furthermore, multivariate analysis showed low-output syndrome (HR 4.301, CI 95% 2.108–8.776, p<0.001) and vasopressin therapy (HR 1.108, CI 95% 1.012–1.213, p = 0.027) significantly influencing necessity of laparotomy.ConclusionPatients who undergo laparotomy for IC after initial cardiac surgery have a substantial in-hospital mortality risk. Early postoperative catecholamine levels do not influence the development of an IC except vasopressin. Elevated lactate remains merely a vague predictive risk factor.

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Vasopressin Aggravates Cardiopulmonary Bypass-Induced Gastric Mucosal Ischemia

Cited by 10 publications

References 35 publications

Vasopressin therapy in cardiac surgery

Vasopressin therapy in cardiac surgery

International Survey on the Use of Arginine Vasopressin in the Postoperative Management of Single Ventricle Patients

Ischemic Colitis after Cardiac Surgery: Can We Foresee the Threat?

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