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Erschienen in:

01.03.2009 | Original

The vasopressin and copeptin response in patients with vasodilatory shock after cardiac surgery: a prospective, controlled study

verfasst von: Stefan Jochberger, Corinna Velik-Salchner, Viktoria D. Mayr, Günter Luckner, Volker Wenzel, Gerda Falkensammer, Hanno Ulmer, Nils Morgenthaler, Walter Hasibeder, Martin W. Dünser

Erschienen in: Intensive Care Medicine | Ausgabe 3/2009

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Abstract

Objective

To evaluate arginine vasopressin (AVP) and copeptin plasma concentrations in patients with vasodilatory shock after cardiac surgery.

Design

Prospective, controlled, clinical study.

Setting

Surgical intensive care unit and cardiac surgery ward in a tertiary university teaching hospital.

Patients and participants

Thirty-three critically ill patients with vasodilatory shock after cardiac surgery and ten control patients undergoing uncomplicated aorto-coronary bypass surgery.

Measurements and results

Hemodynamic, laboratory and clinical data were recorded daily in all patients during the first 7 days after cardiac surgery. At the same time, points blood was withdrawn to determine plasma concentrations of AVP (radioimmunoassay) and copeptin (immunoluminometric assy). Standard tests, a mixed effects model and regression analyses were used for statistical analysis. The course of AVP was significantly different between groups (P < 0.001). While AVP concentrations were lower in the study group on the first postoperative day, they were higher than that in the control group from postoperative day 3 on. There was no difference in the postoperative AVP response between study patients with or without chronic angiotensin-converting enzyme inhibitor therapy. Except during continuous veno-venous hemofiltration, AVP and copeptin correlated significantly with each other (P < 0.001; r = 0.749).

Conclusions

The AVP response to cardiac surgery is significantly different between patients with vasodilatory shock and patients undergoing uncomplicated aorto-coronary bypass surgery. Although no causative relationship between AVP concentrations and cardiovascular instability can be drawn from these results, our data support the hypothesis that inadequately low AVP plasma levels contribute to the failure to restore vascular tone in vasodilatory shock after cardiac surgery.

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Titel: The vasopressin and copeptin response in patients with vasodilatory shock after cardiac surgery: a prospective, controlled study
verfasst von: Stefan Jochberger
Corinna Velik-Salchner
Viktoria D. Mayr
Günter Luckner
Volker Wenzel
Gerda Falkensammer
Hanno Ulmer
Nils Morgenthaler
Walter Hasibeder
Martin W. Dünser
Publikationsdatum: 01.03.2009
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 3/2009
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1279-1

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The vasopressin and copeptin response in patients with vasodilatory shock after cardiac surgery: a prospective, controlled study