Das Shubhadeep, Das Debasis, Dutta Nilanjan, Sharma Manish Kumar, Gajpal Shivani, Halder Susovan, Chakraborty Unmesh, Saha Apu, Saske Bharath, Gupta Shubham
Pediatric Cardiac Intensive Care Unit, Narayana Superspeciality Hospital, Howrah, West Bengal India.
Dept. of Cardiac Surgery, Narayana Superspeciality Hospital, Howrah, West Bengal India.
Indian J Thorac Cardiovasc Surg. 2025 Apr;41(4):395-403. doi: 10.1007/s12055-024-01873-9. Epub 2024 Dec 28.
The Fontan procedure is crucial for managing univentricular heart conditions but can lead to prolonged pleural effusions, affecting recovery and hospital stays. This study evaluated the effectiveness of vasopressin in reducing pleural effusion and improving recovery outcomes following Fontan procedure.
This comparative observational study reviewed patient records from October 2021 to September 2023. Two cohorts were included of 23 patients each: patients who received postoperative vasopressin from October 2022 to September 2023 (VP group) and a historical control group from the previous year (NVP group), excluding those who underwent fenestrated Fontan. Vasopressin was administered postoperatively to the VP group to mitigate pleural effusion. Primary outcomes were the volume and duration of chest tube drainage. Secondary outcomes included hospital and intensive care unit (ICU) stay durations and fluid balance metrics.
There were no significant differences in the primary or secondary outcomes between the vasopressin group and the control group. The median total drain outputs in the VP and NVP groups were 69.4 ml/kg and 53.9 ml/kg, respectively ( = 0.96). The median duration of chest tube stay was 5.5 days for the VP group and 6 days for the NVP group ( = 0.74). Hospital stay duration ( = 0.74) and ICU stay duration ( = 0.82) showed no significant difference.
Vasopressin does not significantly impact chest tube drainage volume or duration, nor does it reduce hospital stays in Fontan patients, suggesting a limited role in managing postoperative pleural effusions. Further research is needed to explore its benefits for specific patient subgroups and acute hemodynamic instabilities postoperatively.
Below is the link to the electronic supplementary material. 10.1007/s12055-024-01873-9.
Fontan手术对于治疗单心室心脏病至关重要，但可能导致长期胸腔积液，影响恢复和住院时间。本研究评估了血管加压素在减少Fontan手术后胸腔积液及改善恢复结果方面的有效性。
这项比较性观察研究回顾了2021年10月至2023年9月的患者记录。纳入了两个队列，每个队列23例患者：2022年10月至2023年9月接受术后血管加压素治疗的患者（VP组）和前一年的历史对照组（NVP组），排除接受开窗Fontan手术的患者。VP组术后给予血管加压素以减轻胸腔积液。主要结局为胸管引流量和引流持续时间。次要结局包括住院时间、重症监护病房（ICU）住院时间和液体平衡指标。
血管加压素组与对照组在主要或次要结局方面均无显著差异。VP组和NVP组的中位总引流量分别为69.4 ml/kg和53.9 ml/kg（P = 0.96）。VP组胸管留置的中位持续时间为5.5天，NVP组为6天（P = 0.74）。住院时间（P = 0.74）和ICU住院时间（P = 0.82）均无显著差异。
血管加压素对胸管引流量或引流持续时间无显著影响，也不能缩短Fontan患者的住院时间，提示其在处理术后胸腔积液方面作用有限。需要进一步研究以探索其对特定患者亚组及术后急性血流动力学不稳定的益处。
以下是电子补充材料的链接。10.1007/s12055-024-01873-9。
