Clinical & Experimental Cardiology
Open Access
ISSN: 2155-9880
ISSN: 2155-9880
Caturla Nicol�s, Schnetzer Natalia, Ovejero Rodrigo, Carnevalini Mariana, Falconi Estela, San Miguel Lucas, Caroli Christian, Waldman Silvina, Cohen Arazi Hern�n
Posters: J Clinic Experiment Cardiol
Introduction: 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. Methods: 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. Results: 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 fibrillation (47%). 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). Discussion: 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.