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Levels of vasopressin in children undergoing cardiopulmonary bypass*

Published online by Cambridge University Press:  07 March 2008

Wynne E. Morrison ,
Shari Simone ,
Dyana Conway ,
Jamie Tumulty ,
Cynthia Johnson  and
Marcelo Cardarelli
Wynne E. Morrison*
Affiliation:
Department of Anesthesia and Critical Care, The Children’s Hospital of Philadelphia & University of Pennsylvania, Philadelphia, Pennsylvania
Shari Simone
Affiliation:
University of Maryland Hospital for Children, Baltimore, Maryland
Dyana Conway
Affiliation:
University of Maryland Hospital for Children, Baltimore, Maryland
Jamie Tumulty
Affiliation:
University of Maryland Hospital for Children, Baltimore, Maryland
Cynthia Johnson
Affiliation:
University of Maryland Hospital for Children, Baltimore, Maryland
Marcelo Cardarelli
Affiliation:
Division of Cardiovascular Surgery, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
*
Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street & Civic Center Blvd, Room 7C26, Philadelphia, PA 19104, United States of America. Tel: +267 426 0296; Fax: +215 590 4327; E-mail: [email protected]
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Abstract

Objectives

It is accepted treatment to give vasopressin to adults in postcardiotomy shock, but such use in children is controversial. Cardiopulmonary bypass is presumed to attenuate the normal endogenous vasopressin response to shock. We hypothesized that levels of vasopressin in children are altered by bypass, and that children having low endogenous levels perioperatively are more likely to develop hypotension, or require vasopressors.

Methods

Serial levels of vasopressin were assessed prospectively in children undergoing bypass at a single center.

Results

Of 61 eligible patients, we enrolled 39 (63%). Their median age was 5 months. The mean level of vasopressin prior to bypass was 18.6 picograms per millilitre, with an interquartile range from 2.6 to 11.4. Levels of vasopressin peaked during bypass at 87.1, this being highly significant compared to baseline (p < 0.00005), remained high for 12 hours at a mean of 73.5, again significantly different from baseline (p = 0.002), were falling at 24 hours, with a mean of 28.1 (p = 0.04), and had returned to baseline by 48 hours, when the mean was 7.4 (p = 0.3). Age, gender, and the category for surgical risk had no influence on the levels of vasopressin. There was no statistically significant relationship between the measured levels and hypotension or the requirement for vasopressors, although a few persistently hypotensive patients had high levels subsequent to bypass. Higher levels correlated with higher levels of sodium in the serum (rs = 0.37, p < 0.00005), higher osmolality (rs = 0.37, p < 0.00005), and positive fluid balance (rs = 0.23, p < 0.008). Preoperative use of inhibitors of angiotensin converting enzyme, preoperative congestive cardiac failure, and longer periods of bypass predicted higher levels during the first eight postoperative hours.

Conclusions

Children do not have deficient endogenous levels of vasopressin following bypass, and lower levels are not associated with hypotension. Any therapeutic efficacy of infusion of vasopressin for post-cardiotomy shock in children is likely due to reasons other than physiologic replacement.

Keywords

neurohormonal axiscongenital heart surgerypost-cardiotomy shock
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 2 , April 2008 , pp. 135 - 140
Copyright
Copyright © Cambridge University Press 2008

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Footnotes

*

This manuscript was presented at the Inaugural Meeting of The World Society for Pediatric and Congenital Heart Surgery in Washington DC, United States of America, May 3 and 4, 2007

References

1. Vincent, JL. Vasopressin in hypotensive and shock states. Crit Care Clin 2006; 22: 187–197.CrossRefGoogle ScholarPubMed
2. Treschan, TA, Peters, J. The vasopressin system: physiology and clinical strategies. Anesthesiology 2006; 105: 599–612.CrossRefGoogle ScholarPubMed
3. Sharshar, T, Blanchard, A, Paillard, M, Raphael, JC, Gajdos, P, Annane, D. Circulating vasopressin levels in septic shock. Crit Care Med 2003; 31: 1752–1758.CrossRefGoogle ScholarPubMed
4. Landry, DW, Oliver, JA. The pathogenesis of vasodilatory shock. N Engl J Med 2001; 345: 588–595.CrossRefGoogle ScholarPubMed
5. Argenziano, M, Chen, JM, Choudhri, AF, et al. Management of vasodilatory shock after cardiac surgery: identification of predisposing factors and use of a novel pressor agent. J Thorac Cardiovasc Surg 1998; 116: 973–980.CrossRefGoogle ScholarPubMed
6. Argenziano, M, Choudhri, AF, Oz, MC, Rose, EA, Smith, CR, Landry, DW. A prospective randomized trial of arginine vasopressin in the treatment of vasodilatory shock after left ventricular assist device placement. Circulation 1997; 96: 286–290.Google ScholarPubMed
7. Barrett, LK, Singer, M, Clapp, LH. Vasopressin: mechanisms of action on the vasculature in health and in septic shock. Crit Care Med 2007; 35: 33–40.CrossRefGoogle ScholarPubMed
8. Landry, DW, Oliver, JA. Vasopressin and relativity: on the matter of deficiency and sensitivity. Crit Care Med 2006; 34: 1275–1277.CrossRefGoogle ScholarPubMed
9. Pollack, MM, Patel, KM, Ruttimann, UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996; 24: 743–752.CrossRefGoogle ScholarPubMed
10. Zuppa, AF, Nadkarni, V, Davis, L, et al. The effect of a thyroid hormone infusion on vasopressor support in critically ill children with cessation of neurologic function. Crit Care Med 2004; 32: 2318–2322.Google ScholarPubMed
11. Goldstein, B, Giroir, B, Randolph, A. Values for systolic blood pressure: authors reply. Pediatr Crit Care Med 2005; 6: 500.CrossRefGoogle Scholar
12. Kindelan, A, Navero, J, De la Rosa, I, et al. Relationship between hemodynamic changes and blood hormone concentrations after cardiac surgery in children with congenital heart disease. Crit Care Med 1994; 22: 1754–1761.CrossRefGoogle Scholar
13. Jochberger, S, Mayr, VD, Luckner, G, et al. Serum vasopressin concentrations in critically ill patients. Crit Care Med 2006; 34: 293–299.CrossRefGoogle ScholarPubMed
14. Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110–118.CrossRefGoogle ScholarPubMed
15. Dunser, MW, Lindner, KH, Wenzel, V. A century of arginine vasopressin research leading to new therapeutic strategies. Anesthesiology 2006; 105: 444–445.CrossRefGoogle ScholarPubMed
16. Shu’ayb, WA, Moran, WH, Zimmerman, B. Studies of the mechanism of antidiuretic hormone secretion and the post-commisurotomy dilutional syndrome. Ann Surg 1965; 162: 690–699.CrossRefGoogle ScholarPubMed
17. Richardson, RL, Giles, H, Pate, JW. Antidiuretic hormone secretion: its relation to cardiac surgery and injury. J Tenn Med Assoc 1969; 62: 1126–1128.Google ScholarPubMed
18. Ationu, A, Singer, DR, Smith, A, Elliott, M, Burch, M, Carter, ND. Studies of cardiopulmonary bypass in children: implications for the regulation of brain natriuretic peptide. Cardiovasc Res 1993; 27: 1538–1541.CrossRefGoogle ScholarPubMed
19. Rosenzweig, EB, Starc, TJ, Chen, JM, et al. Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. Circulation 1999; 100 (Suppl): II182–II186.Google Scholar
20. Boldt, J, Menges, T, Kuhn, D, Diridis, C, Hempelmann, G. Alterations in circulating vasoactive substances in the critically ill--a comparison between survivors and non-survivors. Intensive Care Med 1995; 21: 218–225.CrossRefGoogle ScholarPubMed
21. Lodha, R, Vivekanandhan, S, Sarthi, M, Kabra, SK. Serial circulating vasopressin levels in children with septic shock. Pediatr Crit Care Med 2006; 7: 220–224.CrossRefGoogle ScholarPubMed
22. Killinger, JS, Hsu, DT, Hardart, GE. The incidence of vasodilatory shock (VDS) in children after cardiopulmonary bypass (CPB). Crit Care Med 2006; 34: A61.CrossRefGoogle Scholar
23. Albright, TN, Zimmerman, MA, Selzman, CH. Vasopressin in the cardiac surgery intensive care unit. Am J Crit Care 2002; 11: 326–330.CrossRefGoogle ScholarPubMed