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The effects of phenylephrine and vasopressin use on renal outcomes of open heart surgery patients / by Danielle Berkovitz.

by Berkovitz, Danielle.

Cardiopulmonary bypass -- Adverse effects

Acute renal failure.

Kidneys -- Effect of drugs on.

63 leaves : ill. ; 29 cm.

Thesis advisor: Dr. Ron Gerrits.

Committee members: Dr. Larry Fennigkoh, Shannon Vorborsky.

Introduction -- Background -- Methods -- Results -- Discussion -- Conclusions and recommendations -- A: Minitab results, post-operative creatinine -- B: Minitab results, RIFLE classification.

A subject of debate in the perfusion community is whether the use of the vasoconstrictor vasopressin during cardiopulmonary bypass (CPB) results in better renal outcomes for cardiopulmonary bypass patients than the use of the vasoconstrictor phenylephrine. Studies performed in both animals and humans seem to suggest phenelephrine may decrease renal blood flow. This reduction in renal flow could harm the kidneys, leading to injury or failure. The goal of the present study was to perform a retrospective analysis of renal function of CPB patients and to correlate this with vasoconstrictor use and dose.

Data on surgeries performed between January 2007 and February 2011 were obtained from the Society of Thoracic Surgeons adult cardiac database at Aurora St. Luke's Medical Center, Milwaukee, Wisconsin. These data included information on pre- and post-operative creatinine levels, which were used to classify each patient into a level of renal impairment as outlined by the published RIFLE criteria. Information on phenylephrine usage and dosing was also obtained, as well as whether or not vasopressin was used. Patients were then classified as having been treated with phenylephrine alone (mean post-operative creatinine 1.5 ± 0.87 mg/dL), vasopressin alone (mean post-operative creatinine 1.9 ± 1.8 mg/dL), both drugs (mean post-operative creatinine 1.56 ± 0.91). Additional information included type of surgery, phenylephrine dose, cardiopulmonary bypass time and aortic cross-clamp time. The data were first analyzed using multiple regression models. Follow-up tests included one-way ANOVA and Tukey multiple comparisons tests.

Results demonstrated that neither drug provided solid predictive value with respect to post-operative renal dysfunction. A regression model that took into account a number of variables, including the use of vasoconstrictors, found that CPB time and type of surgery were better predictors of post-operative renal dysfunction than the use of any specific vasoconstrictor. It is recommended that future studies investigate additional predictors of post-operative renal dysfunction.

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