Hemodynamic and Regional Oxygenation Effects of Arginine- Vasopressin Following Congenital Heart Surgery

Arginine-vasopressin may increase blood pressure and regional oxygen extraction in children after cardiac surgery, but potential adverse effects on oxygen balance should be considered.

Summary and findings

This study evaluated the effects of arginine-vasopressin on hemodynamics and regional oxygenation in 49 children following congenital heart surgery. Patients receiving vasopressin (n=23) were compared to those not receiving it (n=26). The results indicated an increase in systolic blood pressure and oxygen extraction in cerebral and renal tissues.

Abstract

<title>Abstract</title> <p>Background: Arginine-vasopressin is widely used for treatment of vasodilatory and mixed shock after pediatric cardiac surgery. Although a favorable effect on blood pressure has been documented, data on organ perfusion and tissue oxygen balance remain limited. <h4>Methods:</h4> We prospectively evaluated an observational cohort of 49 children after reparative cardiac surgery. Median age was 8 months (interquartile range 5 to 59 months) and weight 11.0 kg (interquartile range 7.2 to 26.3 kg). Patients who received arginine-vasopressin (n=23) for hypotension were compared with patients of similar surgical complexity who did not (n=26), using regression analysis. <h4>Results:</h4> Vasopressin dose was independently associated with an increase in systolic blood pressure (p<0.01), an increase in cerebral oxygen extraction (p=0.04), and an increase in renal oxygen extraction (p<0.01). No statistical difference was observed between treated and non-treated patients in diastolic blood pressure, blood lactate, or urine output. <h4>Conclusions:</h4> Arginine-vasopressin therapy restores blood pressure in hypotensive children after cardiac surgery but was associated with increased cerebral and renal oxygen extraction, suggesting possible adverse effects on regional oxygen balance.</p>

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