Skip to main content Accessibility help
×
Home
Hostname: page-component-cf9d5c678-r9vz2 Total loading time: 0.296 Render date: 2021-08-02T11:46:18.343Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Arginine–vasopressin therapy in hypotensive neonates and infants after cardiac surgery: response is unrelated to baseline ventricular function

Published online by Cambridge University Press:  14 December 2016

Ilias Iliopoulos
Affiliation:
Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Heart Institute, Cincinnati, Ohio, United States of America
Saul Flores
Affiliation:
Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Heart Institute, Cincinnati, Ohio, United States of America
J. N. Pratap
Affiliation:
Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Heart Institute, Cincinnati, Ohio, United States of America
David S. Cooper
Affiliation:
Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Heart Institute, Cincinnati, Ohio, United States of America
Amy Cassedy
Affiliation:
Heart Institute Research Core, Cincinnati Children’s Hospital Medical Center, Heart Institute, Cincinnati, Ohio, United States of America
David P. Nelson
Affiliation:
Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Heart Institute, Cincinnati, Ohio, United States of America
Corresponding

Abstract

We hypothesised that infants with ventricular dysfunction after cardiac surgery have impaired haemodynamic response to arginine–vasopressin therapy. We retrospectively reviewed the medical records of neonates and infants treated with arginine–vasopressin within 48 hours of corrective or palliative cardiac surgery who underwent echocardiographic assessment of ventricular function before initiation of therapy. Patients were classified as “responders” if their systolic blood pressure increased by ⩾10% without increase in catecholamine score or if it was maintained with decreased catecholamine score. Response was assessed 1 hour after maximum upward titration of arginine–vasopressin. A total of 36 children (15 neonates) were reviewed (17 male). The median (interquartile) age was 10.4 weeks (1.1–26.9), and the median weight was 4.3 kg (3.2–5.8). Diagnoses included single ventricle (eight), arch abnormalities (five), atrioventricular septal defect (four), double-outlet right ventricle (three), tetralogy of Fallot (three), and others (13). In all, 12 patients (33%) had ventricular dysfunction. Only 15 (42%) responded favourably according to our definition 1 hour after the “target” arginine–vasopressin dose was achieved. Ventricular dysfunction was not associated with poor response. The overall mortality was 25%, but mortality in patients with ventricular dysfunction was 42%. Favourable response was associated with shorter ICU stay (9.5 days versus 19.5 days, p=0.01). We conclude that arginine–vasopressin fails to increase blood pressure in ~50% of hypotensive children after cardiac surgery. The response rate does not increase with duration of therapy. Ventricular function does not predict haemodynamic response. The mortality in this group is very high. Prospective comparison of vasopressin with other vasoactive agents and/or inotropes is warranted.

Type
Original Articles
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Rosenzweig, EB, Starc, TJ, Chen, JM, et al. Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. Circulation 1999; 100 (Suppl): II182II186.CrossRefGoogle Scholar
2. Lechner, E, Hofer, A, Mair, R, Moosbauer, W, Sames-Dolzer, E, Tulzer, G. Arginine-vasopressin in neonates with vasodilatory shock after cardiopulmonary bypass. Eur J Pediatr 2007; 166: 12211227.CrossRefGoogle ScholarPubMed
3. Alten, JA, Borasino, S, Toms, R, Law, MA, Moellinger, A, Dabal, RJ. Early initiation of arginine vasopressin infusion in neonates after complex cardiac surgery. Pediatr Crit Care Med 2012; 13: 300304.CrossRefGoogle ScholarPubMed
4. Mastropietro, CW, Davalos, MC, Seshadri, S, Walters, HL III, Delius, RE. Clinical response to arginine vasopressin therapy after paediatric cardiac surgery. Cardiol Young 2013; 23: 387393.CrossRefGoogle ScholarPubMed
5. Mastropietro, CW, Rossi, NF, Clark, JA, et al. Relative deficiency of arginine vasopressin in children after cardiopulmonary bypass. Crit Care Med 2010; 38: 20522058.CrossRefGoogle Scholar
6. Morrison, WE, Simone, S, Conway, D, Tumulty, J, Johnson, C, Cardarelli, M. Levels of vasopressin in children undergoing cardiopulmonary bypass. Cardiol Young 2008; 18: 135140.CrossRefGoogle ScholarPubMed
7. Indrambarya, T, Boyd, JH, Wang, Y, McConechy, M, Walley, KR. Low-dose vasopressin infusion results in increased mortality and cardiac dysfunction following ischemia-reperfusion injury in mice. Crit Care 2009; 13: R98.CrossRefGoogle ScholarPubMed
8. Mastropietro, CW. Arginine vasopressin in neonates after surgery for congenital heart disease: right from the start? Pediatr Crit Care Med 2012; 13: 360361.CrossRefGoogle ScholarPubMed
9. Gaies, MG, Gurney, JG, Yen, AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234238.CrossRefGoogle ScholarPubMed
10. Asfar, P, Radermacher, P. Vasopressin and ischaemic heart disease: more than coronary vasoconstriction? Crit Care 2009; 13: 169.CrossRefGoogle ScholarPubMed
11. Walker, BR, Childs, ME, Adams, EM. Direct cardiac effects of vasopressin: role of V1- and V2-vasopressinergic receptors. Am J Physiol 1988; 255: H261H265.Google ScholarPubMed
12. Fenton, RA, Brønd, L, Nielsen, S, Praetorius, J. Cellular and subcellular distribution of the type-2 vasopressin receptor in the kidney. Am J Physiol Renal Physiol 2007; 293: F748F760.CrossRefGoogle ScholarPubMed
13. Holmes, CL, Patel, BM, Russell, JA, Walley, KR. Physiology of vasopressin relevant to management of septic shock. Chest 2001; 120: 9891002.CrossRefGoogle ScholarPubMed
14. Diéguez, G, Martínez, MA, Fernández, N, Climént, B, García-Villalón, AL, Monge, L. Vasopressin effects on the coronary circulation after a short ischemia in anesthetized goats: role of nitric oxide and prostanoids. Eur J Pharmacol 2004; 495: 171177.CrossRefGoogle Scholar
15. Noguera, I, Medina, P, Segarra, G, et al. Potentiation by vasopressin of adrenergic vasoconstriction in the rat isolated mesenteric artery. Br J Pharmacol, 122: 431438.CrossRefGoogle ScholarPubMed
16. Lindner, KH, Prengel, AW, Pfenninger, EG, et al. Vasopressin improves vital organ blood flow during closed-chest cardiopulmonary resuscitation in pigs. Circulation 1995; 91: 215221.CrossRefGoogle ScholarPubMed
17. Wilson, MF, Brackett, DJ, Archer, LT, Hinshaw, LB. Mechanisms of impaired cardiac function by vasopressin. Ann Surg 1980; 191: 494500.CrossRefGoogle ScholarPubMed
18. Sellke, FW, Quillen, JE. Altered effects of vasopressin on the coronary circulation after ischemia. J Thorac Cardiovasc Surg 1992; 104: 357363.Google ScholarPubMed
19. Nazari, A, Sadr, SS, Faghihi, M, Imani, A, Moghimian, M. The cardioprotective effect of different doses of vasopressin (AVP) against ischemia-reperfusion injuries in the anesthetized rat heart. Peptides 2011; 32: 24592466.CrossRefGoogle ScholarPubMed
20. Boyle, WA 3rd, Segel, LD. Direct cardiac effects of vasopressin and their reversal by a vascular antagonist. Am J Physiol 1986; 251: H734H741.Google ScholarPubMed
21. Dünser, MW, Hasibeder, WR. Vasopressin in vasodilatory shock: ensure organ blood flow, but take care of the heart!. Crit Care 2006; 10: 172.CrossRefGoogle Scholar
22. Xu, YJ, Gopalakrishnan, V. Vasopressin increases cytosolic free [Ca2+] in the neonatal rat cardiomyocyte. Evidence for V1 subtype receptors. Circ Res 1991; 69: 239245.CrossRefGoogle ScholarPubMed
23. Gassanov, N, Jankowski, M, Danalache, B, et al. Arginine vasopressin-mediated cardiac differentiation: insights into the role of its receptors and nitric oxide signaling. J Biol Chem 2007; 282: 1125511265.CrossRefGoogle ScholarPubMed
24. Gold, J, Cullinane, S, Chen, J, et al. Vasopressin in the treatment of milrinone-induced hypotension in severe heart failure. Am J Cardiol 2000; 85: 506508, A11.CrossRefGoogle ScholarPubMed
25. Dünser, MW, Mayr, AJ, Stallinger, A, et al. Cardiac performance during vasopressin infusion in postcardiotomy shock. Intensive Care Med 2002; 28: 746751.CrossRefGoogle ScholarPubMed
26. Burton, GL, Kaufman, J, Goot, BH, da Cruz, EM. The use of arginine vasopressin in neonates following the Norwood procedure. Cardiol Young 2011; 21: 536544.CrossRefGoogle Scholar
27. Cingolani, HE, Pérez, NG, Cingolani, OH, Ennis, IL. The Anrep effect: 100 years later. Am J Physiol Heart Circ Physiol 2013; 304: H175H182.CrossRefGoogle ScholarPubMed
28. Villa-Abrille, MC, Caldiz, CI, Ennis, IL, et al. The Anrep effect requires transactivation of the epidermal growth factor receptor. J Physiol 2010; 588 (Pt 9): 15791590.CrossRefGoogle ScholarPubMed
29. Asfar, P, Radermacher, P, Hauser, B. Vasopressin and splanchnic blood flow: vasoconstriction does not equal vasoconstriction in every organ. Intensive Care Med 2006; 32: 2123.CrossRefGoogle Scholar
30. Van Haren, FM, Rozendaal, FW, van der Hoeven, JG. The effect of vasopressin on gastric perfusion in catecholamine-dependent patients in septic shock. Chest 2003; 124: 22562260.CrossRefGoogle ScholarPubMed
31. Pelletier, JS, LaBossiere, J, Dicken, B, et al. Low-dose vasopressin improves cardiac function in newborn piglets with acute hypoxia-reoxygenation. Shock 2013; 40: 320326.CrossRefGoogle ScholarPubMed
32. Edwards, RM, Trizna, W, Kinter, LB. Renal microvascular effects of vasopressin and vasopressin antagonists. Am J Physiol 1989; 256 (2 Pt 2): F274F278.Google Scholar
33. Edwards, RM, Grantham, JJ. Inhibition of vasopressin action by vanadate in the cortical collecting tubule. Am J Physiol 1983; 245: F772F777.Google ScholarPubMed
34. Patel, BM, Chittock, DR, Russell, JA, Walley, KR. Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 2002; 96: 576582.CrossRefGoogle ScholarPubMed
35. Reardon, DP, DeGrado, JR, Anger, KE, et al. Early vasopressin reduces incidence of new onset arrhythmias. J Crit Care 2014; 29: 482485.CrossRefGoogle ScholarPubMed
5
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Arginine–vasopressin therapy in hypotensive neonates and infants after cardiac surgery: response is unrelated to baseline ventricular function
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Arginine–vasopressin therapy in hypotensive neonates and infants after cardiac surgery: response is unrelated to baseline ventricular function
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Arginine–vasopressin therapy in hypotensive neonates and infants after cardiac surgery: response is unrelated to baseline ventricular function
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *