Terlipressin in norepinephrine resistant hyperdemic shock post cardiac surgery

Abstract

This was a prospective double-blinded randomized controlled trial conducted on 40 patients with vasoplegic shock unresponsive to nor-epinephrine post cardiac surgery; to evaluate the effectiveness of Terlipressin given in boluses doses in management of refractory vasoplegic shock unresponsive to nor-epinephrine post cardiac surgery Patients included in this study were characterized by age more than 30 yrs. and less than 65 yrs. old, Coronary and valvular heart diseases, Controlled diabetes and blood pressure, Mild renal impairment with creatinine clearance from 50 to 80 ml/min, Ejection fraction more than 50 % Patients who developed hypotension (mean arterial blood pressure less than 60 mmHg) post cardiac surgery will be included in our study. Nor epinephrine and patients who don’t show improvement of blood pressure on noradrenaline infusion will be randomly chosen either to start Terlipressin 1mg /4hrs (group T) and the other group will continue on noradrenaline (group N) titrating dose to achieve desired blood pressure. All of the following was done for all patients as: • Daily Routine Laboratory investigations as ABGs (Arterial Blood Gases). Kidney Function Tests: serum creatinine and blood urea, Central Venous Oxygen Saturation, Lactate level, CBC (complete blood count), Liver Function Tests and APACHE II score). • Repeatedly continuous measured parameters as (Cardiac output index (L/min/m2) Mean arterial blood pressure, Systemic vascular resistance (dyn•s/cm5), Urine output (L/24-h) and Mean Pulmonary artery pressure (echo). • Microbiological studies and Imaging studies as (Echocardiography is required to evaluate cardiac function) Regarding Baseline data, we found that; the mean age of all patients was (52.2 ± 9.7) years. Regarding gender of the patients, (52.5%) of patients were males; while (47.5%) were females. Regarding comparative studies, Comparative study between the 2 groups revealed • Non-significant difference as regards age and sex (p > 0.05). • Highly significant decrease in baseline UOP, MAP and SVR in T group; compared to N group; with highly significant statistical difference (p < 0.01 respectively). • Highly significant increase in baseline CI in T group; compared to N group; with highly significant statistical difference (p < 0.01). • Non-significant difference as regards baseline O2 saturation all comorbidities (HTN, DM, IHD and obesity) (p > 0.05). • Highly significant decrease in baseline pH, SvO2, HCO3 and TLC, in T group; compared to N group; with highly significant statistical difference (p < 0.01 respectively). • Highly significant increase in baseline lactate in T group; compared