Vasopressor Therapy in Cardiac Surgery-An Experts' Consensus Statement.

Hemodynamic conditions with reduced systemic vascular resistance commonly are observed in patients undergoing cardiac surgery and may range from moderate reductions in vascular tone, as a side effect of general anesthetics, to a profound vasodilatory syndrome, often referred to as vasoplegic shock. Therapy with vasopressors is an important pillar in the treatment of these conditions. There is limited guidance on the appropriate choice of vasopressors to restore and optimize systemic vascular tone in patients undergoing cardiac surgery. A panel of experts in the field convened to develop statements and evidence-based recommendations on clinically relevant questions on the use of vasopressors in cardiac surgical patients, using a critical appraisal of the literature following the GRADE system and a modified Delphi process. The authors unanimously and strongly recommend the use of norepinephrine and/or vasopressin for restoration and maintenance of systemic perfusion pressure in cardiac surgical patients; despite that, the authors cannot recommend either of these drugs with respect to the risk of ischemic complications. The authors unanimously and strongly recommend against using dopamine for treating post-cardiac surgery vasoplegic shock and against using methylene blue for purposes other than a rescue therapy. The authors unanimously and weakly recommend that clinicians consider early addition of a second vasopressor (norepinephrine or vasopressin) if adequate vascular tone cannot be restored by a monotherapy with either norepinephrine or vasopressin and to consider using vasopressin as a first-line vasopressor or to add vasopressin to norepinephrine in cardiac surgical patients with pulmonary hypertension or right-sided heart dysfunction.

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Déclaration de conflit d'intérêts

Declaration of Competing Interest All authors received travel support and expense allowances for the participation in the consensus meetings in Vienna and Ghent. Additionally, F.G. reports honoraria for lectures, scientific advice, and travel support by Orion Pharma and Amomed Pharma outside this work; M. Ha. reports honoraria for lectures, scientific advice, and travel support by Edwards Lifesciences, and Amomed Pharma outside this work; S.T. received honoraria for lectures, scientific advice, and travel support by Edwards Lifesciences, scientific advice, and travel support by Orion Pharma, Medtronic, CSL Behring, Edwards Lifesciences, and Amomed Pharma outside this work. All other authors state that they have no further interest to declare.