Effects of Vasopressin Infusion After Pediatric Cardiac Surgery: A Meta-analysis
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REVIEW ARTICLE
Effects of Vasopressin Infusion After Pediatric Cardiac Surgery: A Meta‑analysis Juan S. Farias1 · Enrique G. Villarreal1,9 · Saul Flores2,3 · Christopher W. Mastropietro4,5 · Maggie Vogel6,7 · Kelci Schulz6,7 · Corissa Culichia6,7 · Ilias D. Iliopoulos8 · Ronald A. Bronicki2,3 · Rohit S. Loomba6,7 Received: 27 August 2020 / Accepted: 30 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Vasopressin has been used to augment blood pressure; however, cardiovascular effects after cardiac surgery have not been well established. The primary objective of this study was to survey the current literature and quantify the pooled effect of vasopressin on hemodynamic parameters in children after pediatric cardiac surgery. A systematic review was conducted to identify studies characterizing the hemodynamic effects of vasopressin after pediatric cardiac surgery. Studies were assessed and those of satisfactory quality with pre- and post-vasopressin hemodynamics for each patient were included in the final analyses. 6 studies with 160 patients were included for endpoints during the first 2 h of infusions. Patients who received vasopressin infusion had greater mean, systolic, and diastolic blood pressures and lower heart rates at 2 h after initiation. 8 studies with 338 patients were included for the effects at 24 h. Patients who received vasopressin infusion had lower central venous pressures and decreased lactate concentrations 24 h after initiation. A subset analysis for children with functionally univentricular hearts found significant decrease in inotrope score and central venous pressure. A subset analysis for neonates found significant decrease in inotrope score and fluid balance. Vasopressin leads to decrease in heart rate and increase in blood pressure in the first 2 h of initiation. Later effects include decrease in inotrope score, central venous pressure, fluid balance, and in lactate within the first 24 h. Findings vary in neonates and in those with functionally univentricular hearts although beneficial effects are noted in both. Keywords Vasopressin · Blood pressure · Cardiac surgical procedure · Hemodynamics · Fluid balance · Lactic acid
* Enrique G. Villarreal [email protected] 1
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
2
Texas Children’s Hospital, Houston, TX, USA
3
Baylor College of Medicine, Houston, TX, USA
4
Riley’s Children’s Health, Indianapolis, IN, USA
5
Indiana University School of Medicine, Indianapolis, IN, USA
6
Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
7
Advocate Children’s Heart Institute/Advocate Children’s Hospital, Oak Lawn, IL, USA
8
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
9
Department of Pediatrics, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
Introduction Arginine vasopressin is a polypeptide synthetiz
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