Clinical response to arginine vasopressin therapy after paediatric cardiac surgery
Christopher W Mastropietro1, Maria C Davalos, Shivaprakash Seshadri
1Division of Critical Care, Department of Pediatrics, Wayne State University/Children's Hospital of Michigan, Detroit, Michigan 48201, USA. cmastrop@med.wayne.edu
Insights
Arginine vasopressin improved hemodynamics in 50% of pediatric cardiac surgery patients. Favorable responses were more likely when treatment began later post-operatively, suggesting a potential timing benefit for this vasopressor.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Pharmacology
Background:
- Hemodynamic instability is a significant concern in children post-cardiac surgery.
- Arginine vasopressin is used to manage such instability.
- Predicting response to arginine vasopressin in pediatric patients is crucial for optimizing treatment.
Purpose of the Study:
- To evaluate the hemodynamic response of pediatric patients to arginine vasopressin after cardiac surgery.
- To identify clinical factors associated with a positive response to arginine vasopressin therapy.
Main Methods:
- Retrospective review of 34 pediatric patients (≤6 years) undergoing open-heart surgery.
- Analysis of patients receiving arginine vasopressin within 7 days post-operation.
- Definition of favorable response based on blood pressure and catecholamine score changes at 6 hours.
Main Results:
- Fifty percent (17/34) of patients showed a favorable hemodynamic response to arginine vasopressin.
- Responders experienced significant increases in mean blood pressure (32.2%) and decreases in catecholamine scores (30.1%).
- Later initiation of arginine vasopressin (median 20 hours vs. 6 hours) was associated with favorable response (p=0.032).
Conclusions:
- Arginine vasopressin provides hemodynamic improvement in approximately half of pediatric cardiac surgery patients.
- Delayed initiation of arginine vasopressin may be linked to better outcomes.
- Further research is warranted to elucidate optimal timing and patient selection for arginine vasopressin use.
Objective:
To describe the haemodynamic response of children who receive arginine vasopressin for haemodynamic instability after cardiac surgery and to identify clinical variables associated with a favourable response. Materials and Methods We reviewed patients less than or equal to 6 years undergoing open heart surgery in our institution between January, 2009 and July, 2010 who received arginine vasopressin during the first 7 days post operation. Favourable responders were defined as those in whom blood pressure was increased or maintained and catecholamine score was decreased, or blood pressure was increased by greater than or equal to 10% of baseline and catecholamine score was unchanged at 6 hours following arginine vasopressin initiation.
Results:
Of the 34 patients identified, 17 (50%) patients responded favourably to arginine vasopressin. At 6 hours, the mean blood pressure was increased by 32.2% in responders as compared with 4.6% in non-responders, with a p-value less than 0.001. The mean catecholamine score decreased by 30.1% in responders and increased by 7.6% in non-responders, with a p-value less than 0.001. Anthropometric, demographic, and intra-operative variables were similar in both groups, as was maximum dose of arginine vasopressin. The median time after arrival to the intensive care unit at which arginine vasopressin was initiated, however, was later in those who responded, 20 hours as compared with those who did not, 6 hours, with a p-value equal to 0.032.
Conclusions:
Arginine vasopressin therapy led to haemodynamic improvement in only half of the children in this study, and improvement was more likely to occur if arginine vasopressin was initiated after the post-operative night.
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