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Vasopressor Therapy in Cardiac Surgery-An Experts' Consensus Statement.

Fabio Guarracino1, Marit Habicher2, Sascha Treskatsch3

  • 1Department of Anesthesia and Intensive Care Medicine, University Hospital of Pisa, Pisa, Italy.

Journal of Cardiothoracic and Vascular Anesthesia
|December 18, 2020
PubMed
Summary
This summary is machine-generated.

Norepinephrine and vasopressin are recommended for managing low vascular resistance in cardiac surgery patients. Dopamine is not recommended for vasoplegic shock, and methylene blue is for rescue therapy only.

Keywords:
cardiac surgerydistributive shockhemodynamic therapyvasodilationvasoplegic shockvasopressor therapy

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Area of Science:

  • Cardiology
  • Anesthesiology
  • Pharmacology

Background:

  • Reduced systemic vascular resistance is common in cardiac surgery.
  • Vasoplegic shock can occur as a side effect of anesthesia.
  • Vasopressor therapy is crucial for managing these conditions.

Purpose of the Study:

  • To provide evidence-based recommendations for vasopressor use in cardiac surgery.
  • To guide clinicians in choosing appropriate vasopressors.
  • To address knowledge gaps in vasopressor selection.

Main Methods:

  • Expert panel convened to develop recommendations.
  • Critical appraisal of literature using the GRADE system.
  • Modified Delphi process for consensus building.

Main Results:

  • Strong recommendation for norepinephrine and/or vasopressin to maintain perfusion.
  • No recommendation for norepinephrine or vasopressin regarding ischemic risk.
  • Strong recommendation against dopamine for post-cardiac surgery vasoplegic shock.
  • Recommendation against methylene blue except as rescue therapy.
  • Weak recommendation for early addition of a second vasopressor if monotherapy fails.
  • Consideration for vasopressin as first-line or adjunct therapy in specific patient groups.

Conclusions:

  • Norepinephrine and vasopressin are preferred vasopressors for cardiac surgery patients.
  • Dopamine should be avoided in post-cardiac surgery vasoplegic shock.
  • Methylene blue has limited application.
  • Combination therapy and vasopressin use in specific scenarios are suggested.