Vasoplegic shock is a serious complication of cardiac surgery. Noradrenalin
infusion is the standard treatment for hemodinamic support in this subset of patients, but
it is suggested that vasopressin may be associated with a better tissue peripheral perfusion
profile. The aim of this study was to evaluate the effects of vasopressin treatment on hemodinamic
parameters and tissue peripheral perfusion in vasoplegic shock after cardiac surgery.
It was a retrospective study of 17 patients with vasoplegic shock and organ failure
evidence after on- pump cardiac surgery, with vasoplegic shock that needed a noradrenalin
infusion higher than 20 mcg/min, to achieve a mean artery pressure of 65 mmHg. In this subset
of patients we initiated a vasopressin dose of 0.03 U/min.
A total of 17 patients were included for the analysis. Age 66+/-13 years, male 82%,
median Euroscore 11 (interquartile range (ICR) 25%-75%, 7,38-16,6), bypass time 181 +/-54.
Hemodinamic changes after vasopressin infusion are shown in table 1
Noradrenalin dose was 27 mcg/min (ICR 25-75% 20-40) before vasopressin infusion and 16 mcg/min (ICR 25-75% 9-30) 24 hours
after (p=0.04). 8 patients died (47%), 17 had renal failure (100%), 8 dialysis (47%), 4 had myocardial infarction (23.5%), and 8 atrial
We defined a cutoff value for lactic acid of 2.5 mmol/l, which was the best value to predict death in the ROC curve (area under
the curve=0,84, sensitivity 87.5% specificity 66.7%). The persistence of lactic acid values above 2.5 mmol/l, in the first 24hs was
associated with a ten-fold increase in mortality (OR 10, p=0.04).
Vasopressin maybe considered as an option in cathecolamine resistant vasoplegic shock because of its hemodinamic
profile and is associated with a reduction in noradrenalin dose in these patients. Vasopressin may be associated with better tissue
peripheral perfusion in vasoplegic shock after cardiac surgery, evidenced by a reduction in lactic acid.
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