Management of vasodilatory shock after cardiac surgery

Identification of predisposing factors and use of a novel pressor agent

M. Argenziano, J. M. Chen, A. F. Choudhri, S. Cullinane, Evan S. Garfein, A. D. Weinberg, Jr Smith C.R., E. A. Rose, D. W. Landry, M. C. Oz, R. D. Weisel, K. H. Krieger

Research output: Contribution to journalArticle

263 Citations (Scopus)

Abstract

Background: Cardiopulmonary bypass can be associated with vasodilatory hypotension requiring pressor support. We have previously found arginine vasopressin to be a remarkably effective pressor in a variety of vasodilatory shock states. We investigated the incidence and clinical predictors of vasodilatory shock in a general population of cardiac surgical patients and the effects of low-dose arginine vasopressin as treatment of this syndrome in patients with heart failure. Methods: Patients undergoing cardiopulmonary bypass (n = 145) were studied prospectively. Preoperative ejection fraction, medications, and perioperative hemodynamics were recorded, and postbypass serum arginine vasopressin levels were measured. Vasodilatory shock was defined as a mean arterial pressure lower than 70 mm Hg, a cardiac index greater than 2.5 L/min/m2, and norepinephrine dependence. Predictors of vasodilatory shock were investigated by logistic regression analysis. The hemodynamic responses of patients who received arginine vasopressin infusions for vasodilatory shock after cardiopulmonary bypass for left ventricular assist device placement or heart transplantation were analyzed retrospectively. Results: Eleven of 145 general cardiac surgery patients (8%) met criteria for postbypass vasodilatory shock. By multivariate analysis, an ejection fraction lower than 0.35 and angiotensin-converting enzyme inhibitor use were independent predictors of postbypass vasodilatory shock (relative risks of 9.1 and 11.9, respectively). Vasodilatory shock was associated with inappropriately low serum arginine vasopressin concentrations (12.0 ± 6.6 pg/mL). Retrospective analysis found 40 patients with postbypass vasodilatory shock who received low-dose arginine vasopressin infusions, resulting in increased mean arterial pressure and decreased norepinephrine requirements. Conclusions: Low ejection fraction and angiotensin-converting enzyme inhibitor use are risk factors for postbypass vasodilatory shock, and this syndrome is associated with vasopressin deficiency. In patients exhibiting this syndrome after high-risk cardiac operations, replacement of arginine vasopressin increases blood pressure and reduces catecholamine pressor requirements.

Original languageEnglish (US)
Pages (from-to)973-980
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume116
Issue number6
StatePublished - 1998
Externally publishedYes

Fingerprint

Causality
Thoracic Surgery
Shock
Arginine Vasopressin
Cardiopulmonary Bypass
Angiotensin-Converting Enzyme Inhibitors
Norepinephrine
Arterial Pressure
Hemodynamics
Neurogenic Diabetes Insipidus
Heart-Assist Devices
Heart Transplantation
Serum
Hypotension
Catecholamines
Multivariate Analysis
Heart Failure
Logistic Models
Regression Analysis
Blood Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Argenziano, M., Chen, J. M., Choudhri, A. F., Cullinane, S., Garfein, E. S., Weinberg, A. D., ... Krieger, K. H. (1998). Management of vasodilatory shock after cardiac surgery: Identification of predisposing factors and use of a novel pressor agent. Journal of Thoracic and Cardiovascular Surgery, 116(6), 973-980.

Management of vasodilatory shock after cardiac surgery : Identification of predisposing factors and use of a novel pressor agent. / Argenziano, M.; Chen, J. M.; Choudhri, A. F.; Cullinane, S.; Garfein, Evan S.; Weinberg, A. D.; Smith C.R., Jr; Rose, E. A.; Landry, D. W.; Oz, M. C.; Weisel, R. D.; Krieger, K. H.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 116, No. 6, 1998, p. 973-980.

Research output: Contribution to journalArticle

Argenziano, M, Chen, JM, Choudhri, AF, Cullinane, S, Garfein, ES, Weinberg, AD, Smith C.R., J, Rose, EA, Landry, DW, Oz, MC, Weisel, RD & Krieger, KH 1998, 'Management of vasodilatory shock after cardiac surgery: Identification of predisposing factors and use of a novel pressor agent', Journal of Thoracic and Cardiovascular Surgery, vol. 116, no. 6, pp. 973-980.
Argenziano, M. ; Chen, J. M. ; Choudhri, A. F. ; Cullinane, S. ; Garfein, Evan S. ; Weinberg, A. D. ; Smith C.R., Jr ; Rose, E. A. ; Landry, D. W. ; Oz, M. C. ; Weisel, R. D. ; Krieger, K. H. / Management of vasodilatory shock after cardiac surgery : Identification of predisposing factors and use of a novel pressor agent. In: Journal of Thoracic and Cardiovascular Surgery. 1998 ; Vol. 116, No. 6. pp. 973-980.
@article{f23e8ed8a8fd4ea993aca24fc6f3d2d8,
title = "Management of vasodilatory shock after cardiac surgery: Identification of predisposing factors and use of a novel pressor agent",
abstract = "Background: Cardiopulmonary bypass can be associated with vasodilatory hypotension requiring pressor support. We have previously found arginine vasopressin to be a remarkably effective pressor in a variety of vasodilatory shock states. We investigated the incidence and clinical predictors of vasodilatory shock in a general population of cardiac surgical patients and the effects of low-dose arginine vasopressin as treatment of this syndrome in patients with heart failure. Methods: Patients undergoing cardiopulmonary bypass (n = 145) were studied prospectively. Preoperative ejection fraction, medications, and perioperative hemodynamics were recorded, and postbypass serum arginine vasopressin levels were measured. Vasodilatory shock was defined as a mean arterial pressure lower than 70 mm Hg, a cardiac index greater than 2.5 L/min/m2, and norepinephrine dependence. Predictors of vasodilatory shock were investigated by logistic regression analysis. The hemodynamic responses of patients who received arginine vasopressin infusions for vasodilatory shock after cardiopulmonary bypass for left ventricular assist device placement or heart transplantation were analyzed retrospectively. Results: Eleven of 145 general cardiac surgery patients (8{\%}) met criteria for postbypass vasodilatory shock. By multivariate analysis, an ejection fraction lower than 0.35 and angiotensin-converting enzyme inhibitor use were independent predictors of postbypass vasodilatory shock (relative risks of 9.1 and 11.9, respectively). Vasodilatory shock was associated with inappropriately low serum arginine vasopressin concentrations (12.0 ± 6.6 pg/mL). Retrospective analysis found 40 patients with postbypass vasodilatory shock who received low-dose arginine vasopressin infusions, resulting in increased mean arterial pressure and decreased norepinephrine requirements. Conclusions: Low ejection fraction and angiotensin-converting enzyme inhibitor use are risk factors for postbypass vasodilatory shock, and this syndrome is associated with vasopressin deficiency. In patients exhibiting this syndrome after high-risk cardiac operations, replacement of arginine vasopressin increases blood pressure and reduces catecholamine pressor requirements.",
author = "M. Argenziano and Chen, {J. M.} and Choudhri, {A. F.} and S. Cullinane and Garfein, {Evan S.} and Weinberg, {A. D.} and {Smith C.R.}, Jr and Rose, {E. A.} and Landry, {D. W.} and Oz, {M. C.} and Weisel, {R. D.} and Krieger, {K. H.}",
year = "1998",
language = "English (US)",
volume = "116",
pages = "973--980",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Management of vasodilatory shock after cardiac surgery

T2 - Identification of predisposing factors and use of a novel pressor agent

AU - Argenziano, M.

AU - Chen, J. M.

AU - Choudhri, A. F.

AU - Cullinane, S.

AU - Garfein, Evan S.

AU - Weinberg, A. D.

AU - Smith C.R., Jr

AU - Rose, E. A.

AU - Landry, D. W.

AU - Oz, M. C.

AU - Weisel, R. D.

AU - Krieger, K. H.

PY - 1998

Y1 - 1998

N2 - Background: Cardiopulmonary bypass can be associated with vasodilatory hypotension requiring pressor support. We have previously found arginine vasopressin to be a remarkably effective pressor in a variety of vasodilatory shock states. We investigated the incidence and clinical predictors of vasodilatory shock in a general population of cardiac surgical patients and the effects of low-dose arginine vasopressin as treatment of this syndrome in patients with heart failure. Methods: Patients undergoing cardiopulmonary bypass (n = 145) were studied prospectively. Preoperative ejection fraction, medications, and perioperative hemodynamics were recorded, and postbypass serum arginine vasopressin levels were measured. Vasodilatory shock was defined as a mean arterial pressure lower than 70 mm Hg, a cardiac index greater than 2.5 L/min/m2, and norepinephrine dependence. Predictors of vasodilatory shock were investigated by logistic regression analysis. The hemodynamic responses of patients who received arginine vasopressin infusions for vasodilatory shock after cardiopulmonary bypass for left ventricular assist device placement or heart transplantation were analyzed retrospectively. Results: Eleven of 145 general cardiac surgery patients (8%) met criteria for postbypass vasodilatory shock. By multivariate analysis, an ejection fraction lower than 0.35 and angiotensin-converting enzyme inhibitor use were independent predictors of postbypass vasodilatory shock (relative risks of 9.1 and 11.9, respectively). Vasodilatory shock was associated with inappropriately low serum arginine vasopressin concentrations (12.0 ± 6.6 pg/mL). Retrospective analysis found 40 patients with postbypass vasodilatory shock who received low-dose arginine vasopressin infusions, resulting in increased mean arterial pressure and decreased norepinephrine requirements. Conclusions: Low ejection fraction and angiotensin-converting enzyme inhibitor use are risk factors for postbypass vasodilatory shock, and this syndrome is associated with vasopressin deficiency. In patients exhibiting this syndrome after high-risk cardiac operations, replacement of arginine vasopressin increases blood pressure and reduces catecholamine pressor requirements.

AB - Background: Cardiopulmonary bypass can be associated with vasodilatory hypotension requiring pressor support. We have previously found arginine vasopressin to be a remarkably effective pressor in a variety of vasodilatory shock states. We investigated the incidence and clinical predictors of vasodilatory shock in a general population of cardiac surgical patients and the effects of low-dose arginine vasopressin as treatment of this syndrome in patients with heart failure. Methods: Patients undergoing cardiopulmonary bypass (n = 145) were studied prospectively. Preoperative ejection fraction, medications, and perioperative hemodynamics were recorded, and postbypass serum arginine vasopressin levels were measured. Vasodilatory shock was defined as a mean arterial pressure lower than 70 mm Hg, a cardiac index greater than 2.5 L/min/m2, and norepinephrine dependence. Predictors of vasodilatory shock were investigated by logistic regression analysis. The hemodynamic responses of patients who received arginine vasopressin infusions for vasodilatory shock after cardiopulmonary bypass for left ventricular assist device placement or heart transplantation were analyzed retrospectively. Results: Eleven of 145 general cardiac surgery patients (8%) met criteria for postbypass vasodilatory shock. By multivariate analysis, an ejection fraction lower than 0.35 and angiotensin-converting enzyme inhibitor use were independent predictors of postbypass vasodilatory shock (relative risks of 9.1 and 11.9, respectively). Vasodilatory shock was associated with inappropriately low serum arginine vasopressin concentrations (12.0 ± 6.6 pg/mL). Retrospective analysis found 40 patients with postbypass vasodilatory shock who received low-dose arginine vasopressin infusions, resulting in increased mean arterial pressure and decreased norepinephrine requirements. Conclusions: Low ejection fraction and angiotensin-converting enzyme inhibitor use are risk factors for postbypass vasodilatory shock, and this syndrome is associated with vasopressin deficiency. In patients exhibiting this syndrome after high-risk cardiac operations, replacement of arginine vasopressin increases blood pressure and reduces catecholamine pressor requirements.

UR - http://www.scopus.com/inward/record.url?scp=0031787215&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031787215&partnerID=8YFLogxK

M3 - Article

VL - 116

SP - 973

EP - 980

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 6

ER -