Terlipressin Infusion in Patients with Refractory Hypotension after Cardiac Surgery

Romina Perone , Massimo Simeone, Mario Guariglia, Miranda Picilli, Michele Orlando, Marco Padula, Emanuele Fiore

Ruggi D Aragona University Hospital, Salerno , Italy

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – B

Abstract

BACKGROUND:The aim of this study is to evaluate the effectivness of low dose continous infusion of Terlipressin in the treatment of severe hypotension in cardiosurgical patients and to assess the differences between the groups of survivors and nonsurvivors treated.

METHODS: The study population was 21 patients who developed hypotension after cardiac surgery. Low dose continous infusion of Terlipressin was tritated to obtain a mean arterial pressure of 65±10 mmhg. Systemic, pulmonary, and regional haemodynamic variables were obtained at baseline and after 2 and 4 h. Laboratory surrogate markers of organ dysfunction were tested at baseline and after 12 and 24 h.

RESULTS: Twenty-one patients who were considered gravely ill despite conventional vasoactive agents received terlipressin as rescue therapy, which rapidly yielded significant improvements in all measured hemodynamic and respiratory indices. Mean ± SD arterial blood pressure increased significantly, from 55 ± 17 to 67 ± 16 mm Hg after 20 minutes (p = 0.004) and to 64 ± 15 mm Hg 24 hours after treatment onset (p = 0.001). Twenty-four hours following terlipressin administration, urine output increased, the oxygenation index decreased from 16.5 ± 27.9 to 9.5± 16.7 in the survivors (p = 0.023), while allowing to reduce norepinephrine requirements.

CONCLUSIONS: Terlipressin caused significant improvement in hemodynamic, respiratory, and renal indices in patients with refractory hypotension and low cardiac output after cardiac surgery. Further controlled studies are needed to confirm the drug's safety and efficacy in this population.