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Published on: January 27, 2023
Vasopressin improves hemodynamic status in infants with congenital diaphragmatic hernia
Shannon N Acker1, John P Kinsella2, Steven H Abman3
1Department of Pediatric Surgery, University of Colorado School of Medicine, Aurora, CO.
Insights
Vasopressin effectively stabilized systemic hemodynamics in infants with congenital diaphragmatic hernia (CDH) and refractory hypotension. This treatment reduced the need for extracorporeal membrane oxygenation, suggesting a potential therapeutic role.
Area of Science:
- Pediatric Cardiology
- Neonatology
- Critical Care Medicine
Background:
- Congenital diaphragmatic hernia (CDH) often leads to severe systemic hypotension in neonates.
- Refractory hypotension in CDH infants poses significant management challenges, frequently requiring advanced support.
Purpose of the Study:
- To evaluate the efficacy of vasopressin in stabilizing systemic hemodynamics in infants diagnosed with congenital diaphragmatic hernia (CDH).
- To assess the impact of vasopressin on pulmonary and systemic hemodynamics, and gas exchange in this vulnerable patient population.
Main Methods:
- Retrospective chart review of 13 infants with CDH treated with vasopressin for refractory hypotension.
- Collected data included demographics, respiratory support, hemodynamic parameters, and laboratory values during vasopressin therapy.
Main Results:
- Vasopressin administration led to increased mean arterial pressure and decreased pulmonary/systemic pressure ratio, heart rate, and FiO2.
- Six out of 13 patients no longer required extracorporeal membrane oxygenation (ECMO) after vasopressin initiation.
- Improved left ventricular function and oxygenation index correlated with reduced ECMO necessity. Prolonged use was linked to hyponatremia and increased urine output/sodium.
Conclusions:
- Vasopressin demonstrated effectiveness in stabilizing systemic hemodynamics without negatively impacting pulmonary hemodynamics in a subset of CDH infants.
- These findings suggest vasopressin as a potential therapeutic option for CDH patients experiencing catecholamine-resistant hypotension.
Objective:
To assess the ability of vasopressin to stabilize hemodynamics in infants with systemic hypotension secondary to congenital diaphragmatic hernia (CDH).
Study Design:
A retrospective chart review was performed to identify 13 patients with CDH treated with vasopressin for refractory hypotension to assess the effect of vasopressin on pulmonary and systemic hemodynamics and gas exchange in this setting. Data collected included demographics, respiratory support, inotropic agents, pulmonary and systemic hemodynamics, urine output, and serum and urine sodium levels during vasopressin therapy.
Results:
Vasopressin therapy increased mean arterial pressure and decreased pulmonary/systemic pressure ratio, heart rate, and fraction of inspired oxygen. In 6 of 13 patients, extracorporeal membrane oxygenation therapy was no longer indicated after treatment with vasopressin. Improvement in left ventricular function and oxygenation index after vasopressin initiation was associated with a decreased need for extracorporeal membrane oxygenation therapy. Prolonged vasopressin treatment was associated with hyponatremia, increased urine output, and increased urine sodium.
Conclusions:
Vasopressin stabilized systemic hemodynamics without adverse effects on pulmonary hemodynamics in a subset of infants with CDH. Our results suggest a potential role for vasopressin therapy in patients with CDH with catecholamine-resistant refractory hypotension.
