First experience with Tolvaptan for the treatment of neonates and infants with capillary leak syndrome after cardiac surgery.
Airway Management
Antidiuretic Hormone Receptor Antagonists
/ therapeutic use
Blood Transfusion
Body Weight
/ drug effects
Capillary Leak Syndrome
/ drug therapy
Cardiac Surgical Procedures
/ adverse effects
Diuretics
/ therapeutic use
Female
Fluid Therapy
Humans
Infant
Infant, Newborn
Liver
/ metabolism
Male
Osmoregulation
/ drug effects
Postoperative Complications
/ drug therapy
Retrospective Studies
Sodium
/ blood
Tolvaptan
/ therapeutic use
Urination
/ drug effects
Journal
BMC pediatrics
ISSN: 1471-2431
Titre abrégé: BMC Pediatr
Pays: England
ID NLM: 100967804
Informations de publication
Date de publication:
12 02 2019
12 02 2019
Historique:
received:
05
09
2018
accepted:
28
01
2019
entrez:
14
2
2019
pubmed:
14
2
2019
medline:
5
3
2020
Statut:
epublish
Résumé
Postoperative fluid management in critically ill neonates and infants with capillary leak syndrome (CLS) and extensive volume overload after cardiac surgery on cardiopulmonary bypass is challenging. CLS is often resistant to conventional diuretic therapy, aggravating the course of weaning from invasive ventilation, increasing length of stay on ICU and morbidity and mortality. Tolvaptan (TLV, vasopressin type 2 receptor antagonist) was used as an additive diuretic in neonates and infants with CLS after cardiac surgery. Retrospective analysis of 25 patients with CLS including preoperative and postoperative parameters was performed. Multivariate regression analysis was performed to identify predictors for TLV response. Multivariate analysis identified urinary output during 24 h after TLV administration and mean blood pressure (BP) on day 2 of TLV treatment as predictors for TLV response (AUC = 0.956). Responder showed greater weight reduction (p < 0.0001), earlier weaning from ventilator during TLV (p = 0.0421) and shorter time in the ICU after TLV treatment (p = 0.0155). Serum sodium and serum osmolality increased significantly over time in all patients treated with TLV. In neonates and infants with diuretic-refractory CLS after cardiac surgery, additional aquaretic therapy with TLV showed an increase in urinary output and reduction in bodyweight in patients classified as TLV responder. Increase in urinary output and mean BP on day 2 of treatment were strong predictors for TLV response.
Sections du résumé
BACKGROUND
Postoperative fluid management in critically ill neonates and infants with capillary leak syndrome (CLS) and extensive volume overload after cardiac surgery on cardiopulmonary bypass is challenging. CLS is often resistant to conventional diuretic therapy, aggravating the course of weaning from invasive ventilation, increasing length of stay on ICU and morbidity and mortality.
METHODS
Tolvaptan (TLV, vasopressin type 2 receptor antagonist) was used as an additive diuretic in neonates and infants with CLS after cardiac surgery. Retrospective analysis of 25 patients with CLS including preoperative and postoperative parameters was performed. Multivariate regression analysis was performed to identify predictors for TLV response.
RESULTS
Multivariate analysis identified urinary output during 24 h after TLV administration and mean blood pressure (BP) on day 2 of TLV treatment as predictors for TLV response (AUC = 0.956). Responder showed greater weight reduction (p < 0.0001), earlier weaning from ventilator during TLV (p = 0.0421) and shorter time in the ICU after TLV treatment (p = 0.0155). Serum sodium and serum osmolality increased significantly over time in all patients treated with TLV.
CONCLUSION
In neonates and infants with diuretic-refractory CLS after cardiac surgery, additional aquaretic therapy with TLV showed an increase in urinary output and reduction in bodyweight in patients classified as TLV responder. Increase in urinary output and mean BP on day 2 of treatment were strong predictors for TLV response.
Identifiants
pubmed: 30755181
doi: 10.1186/s12887-019-1418-6
pii: 10.1186/s12887-019-1418-6
pmc: PMC6371520
doi:
Substances chimiques
Antidiuretic Hormone Receptor Antagonists
0
Diuretics
0
Tolvaptan
21G72T1950
Sodium
9NEZ333N27
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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