Terlipressin infusion for prevention of vasoplegic syndrome in patients treated with angiotensin II receptor antagonist undergoing coronary artery bypass graft surgery: a randomized controlled study
Tóm tắt
Preoperative use of renin angiotensin system antagonists has been considered an independent risk factor for development of vasoplegic syndrome. The aim of this study was to demonstrate efficacy of prophylactic terlipressin infusion for prevention of vasoplegic syndrome in patients treated with angiotensin receptor blocker undergoing coronary artery bypass graft surgery. One hundred patients on angiotensin II receptor antagonist [losartan] scheduled for coronary artery bypass surgery were enrolled into this prospective randomized controlled study. Anesthetic technique, surgical technique, and cardiopulmonary bypass management were standardized for all patients. With the start of rewarming, patients were randomized to receive either terlipressin infusion 1.3 μg.kg−1.hour−1, or normal saline infusion. Incidence of vasoplegic syndrome score was used as primary outcome. Hemodynamic parameters, inotropic score, and vasopressor dependency index were used as secondary outcome. Incidence of vasoplegic syndrome was significantly lower in terlipressin group compared to placebo group. Norepinephrine was required in 2 patients of terlipressin versus 15 patients of placebo group. Mean arterial blood pressure was significantly higher in terlipressin group compared to placebo group (81.7 ± 18.5 versus 69.3 ± 20.2 at 60 min after weaning from CBP). Cardiac index was significantly lower in terlipressin group compared to placebo group (2.52 ± 1.48 versus 3.2 ± 1.55). Systemic vascular resistance was significantly higher in terlipressin group compared to placebo group (2438.09 ± 735.13 versus 1575.05 ± 753.54). Inotropic score and vasopressor dependency index were significantly lower in terlipressin group compared to placebo group. Prophylactic terlipressin infusion could prevent development of vasoplegic syndrome in patients treated with angiotensin II receptor antagonist undergoing coronary artery bypass graft surgery. PACTR, PACTR201804003249274, Registered 25/03/2018—retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3249.
Tài liệu tham khảo
Ang CH, Koo OT, Howe TS (2015) Four limb amputations due to peripheral gangrene from inotrope use - Case report and review of the literature. Int J Surg Case Rep 14:63–65
Argenziano M, Chen JM, Choudhri AF, Cullinane S, Garfein E, Weinberg AD, Smith CR Jr, Rose EA, Landry DW, Oz MC (1998) Management of vasodilatory shock after cardiac surgery: identification of predisposing factors and use of a novel pressor agent. J Thorac Cardiovasc Surg 116(6):973–980
Benit E, Vranckx P, Jaspers L, Jackmaert R, Poelmans C, Coninx R (1996) Frequency of a positive modified Allen's test in 1,000 consecutive patients undergoing cardiac catheterization. Cathet Cardiovasc Diagn 38(4):352–354
Birnbaumer M (2000) Vasopressin receptors. Trends Endocrinol Metab 11(10):406–410
Boccara G, Ouattara A, Godet G, Dufresne E, Bertrand M, Riou B, Coriat P (2003) Terlipressin versus norepinephrine to correct refractory arterial hypotension after general anesthesia in patients chronically treated with renin-angiotensin system inhibitors. Anesthesiology 98(6):1338–1344
Cardoso de Castro LU, Ida KK, Otsuki DA, Sanches TR, Volpini RA, EDS B, Malbouisson LS, Andrade L (2016) Vasopressin analog terlipressin attenuates kidney injury in hemorrhagic shock. Trauma Surg Acute Care Open 1(1):e000039
Colson PH, Bernard C, Struck J, Morgenthaler NG, Albat B, Guillon G (2011) Post cardiac surgery vasoplegia is associated with high preoperative copeptin plasma concentration. Critical Care 15(5):R255
Cruz DN, Antonelli M, Fumagalli R, Foltran F, Brienza N, Donati A, Malcangi V, Petrini F, Volta G, Bobbio Pallavicini FM et al (2009) Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA 301(23):2445–2452
Fabrizi F, Dixit V, Messa P, Martin P (2009) Terlipressin for hepatorenal syndrome: A meta-analysis of randomized trials. Int J Artif Organs 32(3):133–140
Fischer GW, Levin MA (2010) Vasoplegia during cardiac surgery: current concepts and management. Semin Thorac Cardiovasc Surg 22(2):140–144
Hasija S, Makhija N, Choudhury M, Hote M, Chauhan S, Kiran U (2010) Prophylactic vasopressin in patients receiving the angiotensin-converting enzyme inhibitor ramipril undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 24(2):230–238
Krag A, Bendtsen F, Mortensen C, Henriksen JH, Moller S (2010) Effects of a single terlipressin administration on cardiac function and perfusion in cirrhosis. Eur J Gastroenterol Hepatol 22(9):1085–1092
Krag A, Moller S, Henriksen JH, Holstein-Rathlou NH, Larsen FS, Bendtsen F (2007) Terlipressin improves renal function in patients with cirrhosis and ascites without hepatorenal syndrome. Hepatology 46(6):1863–1871
Kunstyr J, Lincova D, Mourad M, Lips M, Cermak T, Kotulak T, Blaha J, Rubes D, Matias M, Stritesky M (2008) A retrospective analysis of Terlipressin infusion in patients with refractory hypotension after cardiac surgery. J Cardiovasc Surg (Torino) 49(3):381–387
Ma TK, Kam KK, Yan BP, Lam YY (2010) Renin-angiotensin-aldosterone system blockade for cardiovascular diseases: current status. Br J Pharmacol 160(6):1273–1292
Matsukuma S, Sakamoto K, Nishiyama M, Tamesa T, Yoshino S, Hazama S, Oshibuchi R, Matsuda N, Matsumoto S, Wakamatsu H et al (2015) Prognostic factors in patients with septic shock in digestive surgery who have undergone direct hemoperfusion with polymyxin B-immobilized fibers: a retrospective observational study. J Intensive Care 3:13
Maybauer MO, Maybauer DM, Enkhbaatar P, Traber DL (2008) Physiology of the vasopressin receptors. Best Practice & Research Clinical Anaesthesiology 22(2):253–263
Mekontso-Dessap A, Houel R, Soustelle C, Kirsch M, Thebert D, Loisance DY (2001) Risk factors for post-cardiopulmonary bypass vasoplegia in patients with preserved left ventricular function. Ann Thorac Surg 71(5):1428–1432
Morales DL, Garrido MJ, Madigan JD, Helman DN, Faber J, Williams MR, Landry DW, Oz MC (2003) A double-blind randomized trial: prophylactic vasopressin reduces hypotension after cardiopulmonary bypass. Ann Thorac Surg 75(3):926–930
Morelli A, Ertmer C, Pietropaoli P, Westphal M (2009a) Terlipressin: a promising vasoactive agent in hemodynamic support of septic shock. Expert Opin Pharmacother 10(15):2569–2575
Morelli A, Ertmer C, Rehberg S, Lange M, Orecchioni A, Cecchini V, Bachetoni A, D’Alessandro M, Van Aken H, Pietropaoli P et al (2009b) Continuous terlipressin versus vasopressin infusion in septic shock (TERLIVAP): a randomized, controlled pilot study. Crit Care 13(4):R130
Nantel P, Rene de Cotret P (2010) The evolution of angiotensin blockade in the management of cardiovascular disease. Can J Cardiol 26 Suppl E:7E-13E
Noto A, Lentini S, Versaci A, Giardina M, Risitano DC, Messina R, David A (2009) A retrospective analysis of terlipressin in bolus for the management of refractory vasoplegic hypotension after cardiac surgery. Interact Cardiovasc Thorac Surg 9(4):588–592
Nygren A, Thoren A, Ricksten SE (2006) Vasopressors and intestinal mucosal perfusion after cardiac surgery: Norepinephrine vs. phenylephrine. Crit Care Med 34(3):722–729
Oh YJ, Lee JH, Nam SB, Shim JK, Song JH, Kwak YL (2006) Effects of chronic angiotensin II receptor antagonist and angiotensin-converting enzyme inhibitor treatments on neurohormonal levels and haemodynamics during cardiopulmonary bypass. Br J Anaesth 97(6):792–798
Omar S, Zedan A, Nugent K (2015) Cardiac vasoplegia syndrome: pathophysiology, risk factors and treatment. Am J Med Sci 349(1):80–88
Papadopoulos G, Sintou E, Siminelakis S, Koletsis E, Baikoussis NG, Apostolakis E (2010) Perioperative infusion of low- dose of vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-A double-blind randomized study. J Cardiothorac Surg 5:17
Pesaturo AB, Jennings HR, Voils SA (2006) Terlipressin: vasopressin analog and novel drug for septic shock. Ann Pharmacother 40(12):2170–2177
Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Medicine 8(1)
Summerhill EM, Baram M (2005) Principles of Pulmonary Artery Catheterization in the Critically Ill. Lung 183(3):209–219
Vijayaraghavan K, Deedwania P (2011) Renin-angiotensin-aldosterone blockade for cardiovascular disease prevention. Cardiol Clin 29(1):137–156
Xiao X, Zhang J, Wang Y, Zhou J, Zhu Y, Jiang D, Liu L, Li T (2016) Effects of terlipressin on patients with sepsis via improving tissue blood flow. J Surg Res 200(1):274–282
Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H, Dagenais G, Sleight P, Anderson C (2008) Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 358(15):1547–1559