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Published on: March 27, 2018
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Vasopressin therapy in cardiac surgery
Jordan H Kunkes1,2, William L Baker3, Jonathan A Hammond1,2,4
1Hartford Hospital, Hartford, Connecticut.
Journal of Cardiac Surgery
|January 1, 2019
Summary
Arginine vasopressin (AVP) deficiency causes vasodilatory shock after heart surgery. Low-dose AVP therapy is a safe and effective treatment, reducing the need for catecholamines.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Pharmacology
Background:
- Arginine vasopressin (AVP) is a peptide hormone regulating vascular tone.
- Post-cardiopulmonary bypass (CPB) vasodilatory shock affects ~10% of patients.
- This shock often necessitates high-dose catecholamine vasopressors.
Purpose of the Study:
- To investigate the role of AVP therapy in managing post-cardiac surgery vasodilatory shock.
- To evaluate AVP as a vasopressor in patients undergoing cardiovascular surgery.
Main Methods:
- Systematic review of Medline literature up to September 2018.
- Keywords included AVP, copeptin, and cardiac surgery.
- Focused on studies using AVP for vasodilatory shock post-CPB.
Main Results:
- Relative or absolute AVP deficiency is linked to post-CPB vasodilatory shock.
- Exogenous AVP significantly increases systemic vascular resistance and mean arterial pressure.
- Low-dose AVP (<0.1 U/min) is safe with minimal adverse effects, reducing catecholamine needs.
Conclusions:
- Vasodilatory shock after CPB is often due to AVP deficiency.
- Low-dose AVP, alone or with catecholamines, is a safe and effective treatment for this condition.
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