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Clinical response to arginine vasopressin therapy after paediatric cardiac surgery

Published online by Cambridge University Press:  18 July 2012

Christopher W. Mastropietro ,
Maria C. Davalos ,
Shivaprakash Seshadri ,
Henry L. Walters III  and
Ralph E. Delius
Christopher W. Mastropietro*
Affiliation:
Division of Critical Care, Department of Pediatrics, Wayne State University/Children's Hospital of Michigan, Detroit, Michigan, United States of America
Maria C. Davalos
Affiliation:
Department of Pediatrics, Wayne State University/Children's Hospital of Michigan, Detroit, Michigan, United States of America
Shivaprakash Seshadri
Affiliation:
Department of Cardiovascular Surgery, Wayne State University/Children's Hospital of Michigan, Detroit, Michigan, United States of America
Henry L. Walters III
Affiliation:
Department of Cardiovascular Surgery, Wayne State University/Children's Hospital of Michigan, Detroit, Michigan, United States of America
Ralph E. Delius
Affiliation:
Department of Cardiovascular Surgery, Wayne State University/Children's Hospital of Michigan, Detroit, Michigan, United States of America
*
Correspondence to: Dr C. W. Mastropietro, MD, Department of Pediatrics, Children's Hospital of Michigan, Carl's Building, 4th floor, 3901 Beaubien Street, Detroit, Michigan 48201, United States of America. Tel: 313 745 7495; Fax: 313 966 0105; E-mail: cmastrop@med.wayne.edu
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Abstract

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.

Keywords

Cardiac surgical procedurescardiopulmonary bypasspost-operative care
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 3 , June 2013 , pp. 387 - 393
Copyright
Copyright © Cambridge University Press 2012 

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