Hemodynamic Effect of Norepinephrine Versus Vasopressin on the Pulmonary Circulation in Cardiac Surgery Patients:

Study Overview
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Brief Summary
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The relative increase in the mPAP with the same unit increase in MAP adjusted for baseline, and RV function assessed by GLS, between VP and NE in patients with normal and increased pulmonary artery pressure, who require vasopressor support during cardiac surgery.

Detailed Description
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The specific aims of our study are to compare 1) the relative increase in the mPAP with the same unit increase in MAP adjusted for baseline and 2) RV function assessed by GLS, between VP and NE in patients with normal and increased pulmonary artery pressure, who require vasopressor support during cardiac surgery. We hypothesize that the use of vasopressin compared with norepinephrine induces a lower mPAP-to-MAP ratio, in cardiac surgical patients with and without pulmonary hypertension who require intraoperative vasopressor support. Second, we will test the hypothesis that vasopressin is associated with improved right ventricular global longitudinal strain compared to norepinephrine in patients requiring vasopressor support during cardiac surgery.

Official Title
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Hemodynamic Effect of Norepinephrine Versus Vasopressin on the Pulmonary Circulation in Cardiac Surgery Patients: a Comparative-effectiveness Quality Project

Conditions
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Cardiac Disease

Intervention / Treatment
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* Drug: Norepinephrine
* Drug: Vasopressin


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Adults> 18 years of age Elective cardiac surgery with the use of CPB Patients with pulmonary artery catheter insertion Systemic hypotension (MAP < 70 mmHg) requiring continuous infusion of vasopressor Exclusion Criteria: Transplant surgery Ventricular assist device implantation other than intra-aortic balloon counter-pulsation Pulmonary endarterectomy Thoracoabdominal aneurysm repair Inhalational pulmonary vasodilators (e.g. Epoprostenol) administration before insertion of pulmonary artery catheter Vasopressin is started as the first choice of pressor per clinical staff discretion

Ages Eligible for Study
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Minimum Age: 19 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: The use of vasopressin compared with norepinephrine<br>The investigator hypothesize that the use of vasopressin compared with norepinephrine induces a lower mPAP-to-MAP ratio, in cardiac surgical patients with and without pulmonary hypertension who require intraoperative vasopressor support. | Drug: Vasopressin<br>* Hemodynamic effect of vasopressin on the pulmonary circulation in cardiac surgery patients<br>|
| Active Comparator: The use of norepinephrine compared with vasopressin<br>The investigators will compare GLS between patients who received norepinephrine versus vasopressin intraoperatively. | Drug: Norepinephrine<br>* Hemodynamic effect of norepinephrine on the pulmonary circulation in cardiac surgery patients<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mPAP-to-MAP ratio between patients who received norepinephrine versus vasopressin intraoperatively. | Compare mPAP-to-MAP ratio between patients who received norepinephrine versus vasopressin intraoperatively. Post intervention measurements will be recorded after protamine administration until end of chest closure. | during surgery |