TY - JOUR
T1 - Vasopressor Therapy in Cardiac Surgery—An Experts’ Consensus Statement
AU - Guarracino, Fabio
AU - Habicher, Marit
AU - Treskatsch, Sascha
AU - Sander, Michael
AU - Szekely, Andrea
AU - Paternoster, Gianluca
AU - Salvi, Luca
AU - Lysenko, Lidia
AU - Gaudard, Phillipe
AU - Giannakopoulos, Perikles
AU - Kilger, Erich
AU - Rompola, Amalia
AU - Häberle, Helene
AU - Knotzer, Johann
AU - Schirmer, Uwe
AU - Fellahi, Jean Luc
AU - Hajjar, Ludhmila Abrahao
AU - Kettner, Stephan
AU - Groesdonk, Heinrich Volker
AU - Heringlake, Matthias
N1 - Funding Information:
The study was supported by Amomed Pharma, Vienna, Austria who reimbursed an independent medical consultant (Brigitte Frischer) and the participants attending the consensus conferences for their time and incurred necessary travel expenses.
Publisher Copyright:
© 2020 Elsevier Inc.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - Hemodynamic conditions with reduced systemic vascular resistance commonly are observed in patients undergoing cardiac surgery and may range from moderate reductions in vascular tone, as a side effect of general anesthetics, to a profound vasodilatory syndrome, often referred to as vasoplegic shock. Therapy with vasopressors is an important pillar in the treatment of these conditions. There is limited guidance on the appropriate choice of vasopressors to restore and optimize systemic vascular tone in patients undergoing cardiac surgery. A panel of experts in the field convened to develop statements and evidence-based recommendations on clinically relevant questions on the use of vasopressors in cardiac surgical patients, using a critical appraisal of the literature following the GRADE system and a modified Delphi process. The authors unanimously and strongly recommend the use of norepinephrine and/or vasopressin for restoration and maintenance of systemic perfusion pressure in cardiac surgical patients; despite that, the authors cannot recommend either of these drugs with respect to the risk of ischemic complications. The authors unanimously and strongly recommend against using dopamine for treating post-cardiac surgery vasoplegic shock and against using methylene blue for purposes other than a rescue therapy. The authors unanimously and weakly recommend that clinicians consider early addition of a second vasopressor (norepinephrine or vasopressin) if adequate vascular tone cannot be restored by a monotherapy with either norepinephrine or vasopressin and to consider using vasopressin as a first-line vasopressor or to add vasopressin to norepinephrine in cardiac surgical patients with pulmonary hypertension or right-sided heart dysfunction.
AB - Hemodynamic conditions with reduced systemic vascular resistance commonly are observed in patients undergoing cardiac surgery and may range from moderate reductions in vascular tone, as a side effect of general anesthetics, to a profound vasodilatory syndrome, often referred to as vasoplegic shock. Therapy with vasopressors is an important pillar in the treatment of these conditions. There is limited guidance on the appropriate choice of vasopressors to restore and optimize systemic vascular tone in patients undergoing cardiac surgery. A panel of experts in the field convened to develop statements and evidence-based recommendations on clinically relevant questions on the use of vasopressors in cardiac surgical patients, using a critical appraisal of the literature following the GRADE system and a modified Delphi process. The authors unanimously and strongly recommend the use of norepinephrine and/or vasopressin for restoration and maintenance of systemic perfusion pressure in cardiac surgical patients; despite that, the authors cannot recommend either of these drugs with respect to the risk of ischemic complications. The authors unanimously and strongly recommend against using dopamine for treating post-cardiac surgery vasoplegic shock and against using methylene blue for purposes other than a rescue therapy. The authors unanimously and weakly recommend that clinicians consider early addition of a second vasopressor (norepinephrine or vasopressin) if adequate vascular tone cannot be restored by a monotherapy with either norepinephrine or vasopressin and to consider using vasopressin as a first-line vasopressor or to add vasopressin to norepinephrine in cardiac surgical patients with pulmonary hypertension or right-sided heart dysfunction.
KW - cardiac surgery
KW - distributive shock
KW - hemodynamic therapy
KW - vasodilation
KW - vasoplegic shock
KW - vasopressor therapy
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U2 - 10.1053/j.jvca.2020.11.032
DO - 10.1053/j.jvca.2020.11.032
M3 - Article
AN - SCOPUS:85097764592
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
SN - 1053-0770
ER -