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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2008 June;49(3):381-7
Copyright © 2008 EDIZIONI MINERVA MEDICA
language: English
A retrospective analysis of Terlipressin infusion in patients with refractory hypotension after cardiac surgery
Kunstyr J., Lincova D., Mourad M., Lips M., Cermak T., Kotulak T., Blaha J., Rubes D., Matias M., Stritesky M.
1 Department of Anesthesia, Resuscitation and Intensive Medicine General University Hospital, Prague, Czech Republic 2 Institute of Pharmacology and Toxicology Ist Medical Faculty, Charles University Prague, Czech Republic 3 Department of Cardiac Surgery, Doctor Soliman Fakeeh Hospital, Jeddah, Kingdom of Saudi Arabia
Aim. The aim of this retrospective study was to evaluate the effectiveness of Terlipressin in the treatment of severe hypotension in cardiosurgical patients and to assess the differences between the groups of survivors and nonsurvivors.
Methods. The study population was 27 patients who developed hypotension after cardiac surgery.
Results. All surviving patients developed refractory hypotension early after extracorporeal circulation. Of the 9 nonsurvivors, 3 also experienced postcardiotomy hypotension, while the remaining 6 developed severe hypotension during sepsis. Terlipressin given continuously significantly increased the mean arterial pressure and reduced the heart rate in both groups. Norepinephrine requirements decreased significantly among survivors only. The mean pulmonary artery pressure and pulmonary capillary wedge pressure levels remained unchanged or increased insignificantly, while several liver markers in the survivor group significantly increased.
Conclusion. Terlipressin given continuously is a potent vasopressor in patients with norepinephrine-resistant postcardiotomy hypotension; however, Terlipressin treatment failed in patients who developed refractory hypotension during sepsis. We cannot recommend this therapy in such patients as it proved to be hemodynamicaly ineffective and may even worsen the circulatory situation.