The acute influence of vasopressin on hemodynamic status and tissue oxygenation following the Norwood procedureCentral MessagePerspective
Ronald A. Bronicki, MD,
Sebastian Acosta, PhD,
Fabio Savorgnan, MD,
Saul Flores, MD,
Barbara-Jo Achuff, MD,
Rohit Loomba, MD,
Mubbasheer Ahmed, MD,
Nancy Ghanayem, MD, MS,
Jeffrey S. Heinle, MD,
Vicken Asadourian, BS,
Javier J. Lasa, MD
Affiliations
Ronald A. Bronicki, MD
Division of Critical Care Medicine & Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
Sebastian Acosta, PhD
Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
Fabio Savorgnan, MD
Division of Critical Care Medicine & Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
Saul Flores, MD
Division of Critical Care Medicine & Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
Barbara-Jo Achuff, MD
Division of Critical Care Medicine & Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
Rohit Loomba, MD
Division of Pediatric Cardiology, Department of Pediatrics, Advocate Children's Hospital, Chicago Medical School/Rosalind Franklin University of Medicine, Oak Lawn, Ill
Mubbasheer Ahmed, MD
Division of Critical Care Medicine & Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
Nancy Ghanayem, MD, MS
Section of Critical Care Medicine, Comer Children's Hospital, University of Chicago School of Medicine, Chicago, Ill
Jeffrey S. Heinle, MD
Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
Vicken Asadourian, BS
Medical Informatics Corporation, Houston, Tex
Javier J. Lasa, MD
Division of Critical Care Medicine & Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex; Address for reprints: Javier J. Lasa, MD, Division of Critical Care Medicine & Cardiology, Department of Pediatrics, Texas Children's Hospital, 6651 Main St, MC: E1420, Houston, TX 77030.
Objectives: Arginine vasopressin (AVP) is used to treat hypotension. Because AVP increases blood pressure by increasing systemic vascular resistance, it may have an adverse effect on tissue oxygenation following the Norwood procedure. Methods: Retrospective analysis of continuously captured hemodynamic data of neonates receiving AVP following the Norwood procedure. Results: We studied 64 neonates exposed to AVP within 7 days after the Norwood procedure. For the entire group, AVP significantly increased mean blood pressure (2.5 ± 6.3) and cerebral and renal oxygen extraction ratios (4.1% ± 9.6% and 2.0% ± 4.7%, respectively; P < .001 for all values). In the right ventricle to pulmonary artery shunt cohort, AVP significantly increased blood pressure, arterial oxygen saturation (1.4% ± 3.8%; P = .011), pulmonary to systemic perfusion ratio (0.2 ± 0.4; P = .017), and cerebral and renal oxygen extraction ratios (4.6% ± 8.7%; P = .010% and 4.7% ± 9.4%; P = .014, respectively). The Blalock-Taussig shunt cohort experienced a less significant vasopressor response and no change in arterial oxygen saturation, pulmonary to systemic perfusion ratio, or cerebral and renal oxygen extraction ratios. Conclusions: The right ventricle to pulmonary artery shunt cohort experienced a significant vasopressor response to AVP that was associated with a significant increase in pulmonary perfusion and decrease in cerebral and renal perfusion, whereas the Blalock-Taussig shunt cohort experienced a less significant vasopressor response and no change in pulmonary or systemic perfusion. The influence of AVP on tissue oxygenation following the Norwood procedure may have clinical implications that require further study.
