Vasopressin Versus Norepinephrine for the Management of Shock After Cardiac Surgery (VaNCS study): a randomized controlled trial

Hajjar, L; Vincent, Jean‐Louis; Rhodes, Andrew; Annane, D; Galas, F; Almeida, J; Câmara, Leandro Teixeira; Santos, Vera Costa; Pereira, Janet; Osawa, E; Maciel, Ethel Leonor Nóia; Rodrigues, Adriano Rogério Baldacin; Jardim, Jaquelline Maria; Blini, D; Araujo, E; Bergamin, F; Filho, R. Kalil; Auler, J

doi:10.1186/cc12160

Cited by 19 publications

(21 citation statements)

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“…For patients who have already developed vasoplegia, a randomized clinical trial revealed that those who went on to receive vasopressin instead of norepinephrine had fewer postoperative complications. 25 Furthermore, a literature review regarding the use of methylene blue (MB) as a treatment for vasoplegia confirmed that MB is safe if used within the recommended dosage and is useful for treating vasoplegia, although its benefit is time-dependent. 26 A newer study reiterated this finding; CPB patients who received MB in the operating room (early administration) had a mortality rate of 10.8% compared with 28.6% among those who received MB in the intensive care unit (late administration).…”

Section: Discussionmentioning

confidence: 99%

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Tecson

Lima

Lee

et al. 2018

JAHA

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BackgroundVasoplegia is associated with adverse outcomes following cardiac surgery; however, its impact following left ventricular assist device implantation is largely unexplored.Methods and ResultsIn 252 consecutive patients receiving a left ventricular assist device, vasoplegia was defined as the occurrence of normal cardiac function and index but with the need for intravenous vasopressors within 48 hours following surgery for >24 hours to maintain a mean arterial pressure >70 mm Hg. We further categorized vasoplegia as none; mild, requiring 1 vasopressor (vasopressin, norepinephrine, or high‐dose epinephrine [>5 μg/min]); or moderate to severe, requiring ≥2 vasopressors. Predictors of vasoplegia severity were determined using a cumulative logit (ordinal logistic regression) model, and 1‐year mortality was evaluated using competing‐risks survival analysis. In total, 67 (26.6%) patients developed mild vasoplegia and 57 (22.6%) developed moderate to severe vasoplegia. The multivariable model for vasoplegia severity utilized preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, central venous pressure, systolic blood pressure, and intraoperative cardiopulmonary bypass time, which yielded an area under the curve of 0.76. Although no significant differences were noted in stroke or pump thrombosis rates (P=0.87 and P=0.66, respectively), respiratory failure and major bleeding increased with vasoplegia severity (P<0.01). Those with moderate to severe vasoplegia had a significantly higher risk of mortality than those without vasoplegia (adjusted hazard ratio: 2.12; 95% confidence interval, 1.08–4.18; P=0.03).ConclusionsVasoplegia is predictive of unfavorable outcomes, including mortality. Risk factors for future research include preoperative INTERMACS profile, central venous pressure, systolic blood pressure, and intraoperative cardiopulmonary bypass time.

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Section: Discussionmentioning

confidence: 99%

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Tecson

Lima

Lee

et al. 2018

JAHA

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“…153 In a recent RCT of patients with vasoplegic shock (defined as mean arterial pressure <65 mm Hg resistant to fluid challenge and cardiac index >2.2 L/min per m 2 ) after cardiac surgery, vasopressin was associated with lower incidence of severe AKI (stages 2 and 3) and RRT use, although, again, study limitations prevent recommendation and further research is needed. 154…”

Section: Pharmacological Strategiesmentioning

confidence: 99%

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

Nadim

Forni

Bïhorac

et al. 2018

JAHA

218

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“…There was no difference in mortality at 90 days ( Figure 5). 37 While these findings are encouraging for AVP as monotherapy, the rates of postop complication and postop atrial fibrillation were very high in both groups. The improved primary outcome in the AVP group was driven by a reduction in renal failure, likely due to the high doses doses of norepinephrine that were needed.…”

Section: Prohylactic Use Of Avp Is Less Well Established Although Stumentioning

confidence: 84%

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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Vasopressin Versus Norepinephrine for the Management of Shock After Cardiac Surgery (VaNCS study): a randomized controlled trial

Cited by 19 publications

References 0 publications

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

Vasopressin therapy in cardiac surgery

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