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Effects of Vasopressin Infusion After Pediatric Cardiac Surgery: A Meta-analysis

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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.

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Funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico

    Juan S. Farias & Enrique G. Villarreal

  2. Texas Children’s Hospital, Houston, TX, USA

    Saul Flores & Ronald A. Bronicki

  3. Baylor College of Medicine, Houston, TX, USA

    Saul Flores & Ronald A. Bronicki

  4. Riley’s Children’s Health, Indianapolis, IN, USA

    Christopher W. Mastropietro

  5. Indiana University School of Medicine, Indianapolis, IN, USA

    Christopher W. Mastropietro

  6. Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA

    Maggie Vogel, Kelci Schulz, Corissa Culichia & Rohit S. Loomba

  7. Advocate Children’s Heart Institute/Advocate Children’s Hospital, Oak Lawn, IL, USA

    Maggie Vogel, Kelci Schulz, Corissa Culichia & Rohit S. Loomba

  8. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Ilias D. Iliopoulos

  9. Department of Pediatrics, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico

    Enrique G. Villarreal

Authors
  1. Juan S. Farias
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  2. Enrique G. Villarreal
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  3. Saul Flores
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  4. Christopher W. Mastropietro
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  5. Maggie Vogel
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  6. Kelci Schulz
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  7. Corissa Culichia
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  8. Ilias D. Iliopoulos
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  9. Ronald A. Bronicki
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  10. Rohit S. Loomba
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Contributions

RSL, SF, and KS contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JSF, CC, MV, and II. The first draft of the manuscript was written by JSF, EGV, and RSL. SF commented on previous versions of the manuscript. All authors read and approved the final manuscript. Reviewing and editing was done by CWM and RAB.

Corresponding author

Correspondence to Enrique G. Villarreal.

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The authors declare that they have no conflict of interest.

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The study has been approved by the appropriate institutional ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Farias, J.S., Villarreal, E.G., Flores, S. et al. Effects of Vasopressin Infusion After Pediatric Cardiac Surgery: A Meta-analysis. Pediatr Cardiol 42, 225–233 (2021). https://doi.org/10.1007/s00246-020-02496-8

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  • DOI: https://doi.org/10.1007/s00246-020-02496-8

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