Grace Korkames, BCCCP, PharmD
Clinical Pharmacy Specialist - Medical Intensive Care Unit
Banner University Medical Center Phoenix
Phoenix, Arizona
Disclosure information not submitted.
Heidi Brink, PharmD, BCPS, BCCP
Pharmacy Case Management Coordinator – Cardiothoracic Transplant
Nebraska Medicine, United States
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Gregory Peitz, PharmD, BCCCP, FCCM
Clinical Associate Professor and Critical Care Coordinator
Nebraska Medicine
Omaha, Nebraska, United States
Disclosure information not submitted.
Title: Effect of Norepinephrine Versus Vasopressin on Pulmonary Artery Pressure
INTRODUCTION/HYPOTHESIS: Patients with ongoing pulmonary hypertension (PH) may be admitted to the intensive care unit (ICU) for varying reasons, one being systemic hypotension requiring vasopressor therapy. Literature supporting the use of norepinephrine (NE) or arginine vasopressin (AVP) in pulmonary hypertension primarily exists in animal studies and case series. The purpose of this study was to examine the effects of NE and AVP on pulmonary and systemic hemodynamic parameters in the setting of PH.
Methods: This retrospective analysis included adult patients admitted between August 2012 – August 2020. ICU patients with a pulmonary artery catheter who were receiving a continuous infusion of either NE or AVP for a minimum of one hour were included. Patients were excluded if they had concomitant NE or AVP use, systemic prostacyclin therapy, extracorporeal membrane oxygenation support, or had any titrations in other vasoactive drugs during the observation period The primary outcome of interest was the percent change in mean pulmonary artery pressure (MPAP) one hour after the initiation of NE or AVP.
Results: Of the 400 patients screened, 33 were included in the study (22 NE and 11 AVP patients). The patients were mostly male (81.8%) and primarily admitted for cardiac surgery (48.5%). The percent change in MPAP between groups was not different one hour after the start of NE or AVP (4.92% vs 1.41%, p=0.731). At six hours, NE had a positive percent change in MPAP compared to AVP (2.27% vs 12.14%, p=0.018). Percent change in mean arterial pressure (MAP) was similar between the two groups at all times observed. Both agents demonstrated increases in systemic vascular resistance (SVR) at one hour after the start of study drug (NE 6.81% vs AVP 8.85%, p=0.047). The percent change in cardiac index at one and two hours after study drug initiation differed between the groups (NE 7.13% vs AVP -11.54%, p=0.002 and NE 9.52% vs AVP-14.81%, p=0.006).
Conclusion: Compared to the NE cohort, the AVP cohort experienced a trend towards decreased MPAP with a difference observed at six hours. Both groups experienced increased peripheral vasoconstriction represented by increases in MAP and SVR. Further trials should be conducted to explore these agents’ effects on pulmonary vasculature.