Vasopressin as Therapy During Nonocclusive Mesenteric Ischemia
Hagen Bomberg1, Heinrich V Groesdonk2, Miriam Raffel3
1Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany; Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany.
The Annals of Thoracic Surgery
|May 14, 2016
Summary
Vasopressin as rescue therapy improved blood pressure and intestinal perfusion in patients with nonocclusive mesenteric ischemia (NOMI) after cardiac surgery. This vasopressor use was associated with better survival rates in this critical patient group.
Area of Science:
- Cardiovascular Medicine
- Gastroenterology
- Critical Care Medicine
Background:
- Vasopressin is utilized to manage vasodilatory shock post-cardiopulmonary bypass (CPB).
- Nonocclusive mesenteric ischemia (NOMI) is a serious complication following cardiac surgery.
- This study investigates vasopressin's role in NOMI patients with refractory hypotension.
Purpose of the Study:
- To evaluate the efficacy of vasopressin as an adjunct therapy in patients with NOMI.
- To assess the impact of vasopressin on intestinal perfusion and hemodynamics.
- To determine the association between vasopressin use and hospital survival in NOMI patients.
Main Methods:
- An observational cohort study of 78 patients treated for NOMI post-cardiac operation.
- Norepinephrine was administered as a vasopressor to all patients.
- Vasopressin was used as rescue therapy in 11 patients with persistent hypotension.
- Intestinal perfusion was monitored via mesenteric angiography.
Main Results:
- Patients receiving vasopressin had higher initial norepinephrine requirements and more severe NOMI.
- After treatment, vasopressin recipients showed improved intestinal perfusion.
- Vasopressin group had significantly lower norepinephrine doses post-treatment and 100% hospital survival.
- The norepinephrine-only group had a 25% mortality rate.
Conclusions:
- Vasopressin administration appears to enhance small intestine perfusion in NOMI patients.
- Adjunctive vasopressin therapy in NOMI post-CPB is linked to improved hospital survival.
- Vasopressin is a valuable rescue therapy for refractory hypotension in NOMI.
