Hospital Universitario Miguel Servet, Zaragoza, Spain.
Hospital Universitario Miguel Servet, Zaragoza, Spain.
Med Intensiva (Engl Ed). 2024 Jul;48(7):392-402. doi: 10.1016/j.medine.2024.04.003. Epub 2024 May 1.
Analyzing associated factors with vasoplegic shock in the postoperative period of Cardiac Surgery. Analyzing the influence of vasopressin as rescue therapy to first-line treatment with norepinephrine.
Cohort, prospective and observational study.
Main hospital Postoperative Cardiac ICU.
Patients undergoing cardiac surgery with subsequent ICU admission from January 2021 to December 2022.
Record of presurgical, perioperative and ICU discharge clinical variables.
chronic treatment, presence of vasoplegic shock, need for vasopressin, cardiopulmonary bypass time, mortality.
773 patients met the inclusion criteria. The average age was 67.3, with predominance of males (65.7%). Post-CPB vasoplegia was documented in 94 patients (12.2%). In multivariate analysis, vasoplegia was associated with age, female sex, presurgical creatinine levels, cardiopulmonary bypass time, lactate level upon admission to the ICU, and need for prothrombin complex transfusion. Of the patients who developed vasoplegia, 18 (19%) required rescue vasopressin, associated with pre-surgical intake of ACEIs/ARBs, worse Euroscore score and longer cardiopulmonary bypass time. Refractory vasoplegia with vasopressin requirement was associated with increased morbidity and mortality.
Postcardiopulmonary bypass vasoplegia is associated with increased mortality and morbidity. Shortening cardiopulmonary bypass times and minimizing products blood transfusion could reduce its development. Removing ACEIs and ARBs prior to surgery could reduce the incidence of refractory vasoplegia requiring rescue with vasopressin. The first-line treatment is norepinephrine and rescue treatment with VSP is a good choice in refractory situations. The first-line treatment of this syndrome is norepinephrine, although rescue with vasopressin is a good complement in refractory situations.
分析心脏手术后血管扩张性休克的相关因素。分析血管加压素作为去甲肾上腺素一线治疗的抢救治疗的影响。
队列、前瞻性和观察性研究。
主要医院心脏手术后 ICU。
2021 年 1 月至 2022 年 12 月接受心脏手术并随后入住 ICU 的患者。
记录术前、围手术期和 ICU 出院的临床变量。
慢性治疗、存在血管扩张性休克、需要血管加压素、体外循环时间、死亡率。
773 名患者符合纳入标准。平均年龄为 67.3 岁，男性居多（65.7%）。94 名患者（12.2%）出现 CPB 后血管扩张。多变量分析显示，血管扩张与年龄、女性、术前肌酐水平、体外循环时间、入住 ICU 时的乳酸水平以及需要凝血酶原复合物输注有关。在发生血管扩张的患者中，18 名（19%）需要抢救性血管加压素，与术前服用 ACEI/ARB、Euroscore 评分较差和体外循环时间较长有关。需要血管加压素治疗的难治性血管扩张与发病率和死亡率增加有关。
CPB 后血管扩张与死亡率和发病率增加有关。缩短体外循环时间和减少输血产品可减少其发生。手术前停用 ACEI 和 ARB 可降低需要血管加压素抢救治疗的难治性血管扩张发生率。一线治疗是去甲肾上腺素，在难治性情况下，使用 VSP 进行抢救治疗是一个不错的选择。该综合征的一线治疗是去甲肾上腺素，尽管在难治性情况下血管加压素是一种很好的补充。
