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Norepinephrine for hypotensive vasodilatation after cardiac surgery: impact on renal function

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Abstract

Objectives

Norepinephrine use in patients after cardiac surgery is controversial because of the fear that norepinephrine might decrease kidney function through regional vasoconstriction. Accordingly, we studied the renal effects of norepinephrine use for hypotensive vasodilatation after cardiac surgery.

Design and setting

Retrospective controlled study in the cardiothoracic ICU of tertiary hospital.

Patients

100 cardiac surgery patients with post-operative hypotensive vasodilatation and 100 control cardiac surgery patients.

Intervention

Treatment of hypotension (MAP<70 mmHg) with continuous norepinephrine infusion.

Measurements and results

We collected data on demographic and surgical characteristics, haemodynamics, serum creatinine and mortality. Just after surgery the norepinephrine group had a significantly higher mean central venous pressure, lower mean arterial pressure, and lower systemic vascular resistance index with a similarly elevated mean cardiac index. Despite norepinephrine administration at a mean peak dose of 7.3±6.4 µg/min the mean post-operative change in creatinine was not different between two groups on days 0, 2 or 4 after surgery.

Conclusions

Norepinephrine does not increase post-operative serum creatinine concentrations in patients with hypotensive vasodilatation after cardiac surgery. Concerns related to its potential adverse effects on the kidney function in this setting appear unjustified.

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Authors and Affiliations

  1. Departments of Intensive Care and Medicine, Austin and Repatriation Medical Centre, Melbourne University, Studley Road, Heidelberg, 3084, Melbourne, Victoria, Australia

    Hiroshi Morimatsu, Shigehiko Uchino & Rinaldo Bellomo

  2. Department of Cardiothoracic Surgery, Austin and Repatriation Medical Centre, Studley Road, Heidelberg, 3084, Melbourne, Victoria, Australia

    John Chung, Jai Raman & Brian Buxton

Authors
  1. Hiroshi Morimatsu
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  2. Shigehiko Uchino
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  3. John Chung
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  4. Rinaldo Bellomo
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  5. Jai Raman
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  6. Brian Buxton
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Corresponding author

Correspondence to Rinaldo Bellomo.

Additional information

This study was supported by the Austin and Repatriation Medical Centre Intensive Care Research Fund

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Morimatsu, H., Uchino, S., Chung, J. et al. Norepinephrine for hypotensive vasodilatation after cardiac surgery: impact on renal function. Intensive Care Med 29, 1106–1112 (2003). https://doi.org/10.1007/s00134-003-1810-3

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  • DOI: https://doi.org/10.1007/s00134-003-1810-3

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