Vasopressin or Norepinephrine in Vasoplegic Shock After Non-cardiac Surgery
- Conditions
- Circulatory ShockNon-cardiac Surgery
- Interventions
- Registration Number
- NCT03483753
- Lead Sponsor
- University of Sao Paulo
- Brief Summary
The purpose of the present study is to evaluate the effect of vasopressin compared to norepinephrine on the clinical complications of patients with vasospastic shock after noncardiac surgeries.
- Detailed Description
The Systemic Inflammatory Response Syndrome (SIRS) is a common complication after non-cardiac surgery, impacting negatively on patient outcome and with high incidence rates. Vasoplegic syndrome is the most serious complication of SIRS and can happen after any type of surgery. The etiology of the vasoplegic syndrome has not yet been fully elucidated, but is known to occur more frequently in patients at high surgical risk, submitted to major surgeries, or in the presence of perioperative complications and patients with comorbidities. In this circumstance, the depletion of vasopressin stocks is described, which may contribute to the refractoriness of the shock and the lack of response to the catecholaminergic drugs. The standard treatment of perioperative vasoplegia has been adequate volume replacement and administration of vasopressors, with norepinephrine being the most commonly used. However, it is known that norepinephrine may have deleterious effects on the body and in 20% of patients with vasospastic shock it is ineffective. Previous studies have suggested benefits of adding vasopressin in refractory situations, especially in septic shock. Recently the VANCS study (Vasopressin or norepinephrine in the vasopregic shock after cardiac surgery: double-blind, controlled and randomized study) demonstrated superiority of vasopressin in the reversion of vasoplegic shock after cardiac surgery, as well as a lower incidence of renal insufficiency, atrial fibrillation and shorter hospitalization time. (Anesthesiology. 2017 Jan;126(1):85-93.)
Recruitment & Eligibility
- Status
- WITHDRAWN
- Sex
- All
- Target Recruitment
- Not specified
- Age greater than 18 years;
- Patients undergoing high-risk non-cardiac surgery;
- vasopressor need within 24 hours after surgery, defined as mean arterial pressure (MAP) <65 mmHg after volume resuscitation with at least 1 liter of crystalloid solution (Ringer's lactate) and maintaining a cardiac index> 2.2 ml / min / m²;
- Signature of the informed consent form.
- Allergy to vasoactive drugs;
- Previous use of vasopressor;
- Gestation;
- Presence of Raynaud's phenomenon, altered Allen's test, systemic sclerosis or vasospastic diathesis;
- Severe hyponatremia (Na <130 mEq / L);
- Acute mesenteric ischemia;
- Acute coronary syndrome;
- Participation in another study;
- Refusal to participate in the study.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Vasopressin group Vasopressin Blinded vasopressin Norepinephrine group Norepinephrine Blinded norepinephrine
- Primary Outcome Measures
Name Time Method Incidence between groups of a composite outcome of all-cause mortality, cardiovascular and renal complications after high-risk non-cardiac surgeries 30 days Cardiovascular complications include: stroke, acute myocardial infarction, cardiogenic shock, nonfatal myocardial injury, and ventricular or supraventricular arrhythmias.
Renal complications: Acute renal failure with AKIN stage 1 or higher or renal support therapy.
- Secondary Outcome Measures
Name Time Method Reoperation 30 days number of patients who required reoperation
Cardiogenic shock 30 days after randomization to compare between groups the incidence of cardiogenic shock
Septic shock 30 days to compare between groups the incidence of septic shock
Length of time in the Intensive Care Unit (ICU) and hospital 30 days Length of time in the Intensive Care Unit (ICU) and hospital
All-cause mortality 30 days after randomization mortality rate of any cause
Ventricular and / or supraventricular arrhythmia 30 days to compare between groups the incidence of Ventricular and / or supraventricular arrhythmia
Acute respiratory distress syndrome (ARDS) 30 days to compare between groups the incidence of Acute respiratory distress syndrome (ARDS)
hospital and ICU readmission rate 30 days hospital and ICU readmission rate
Stroke and transient ischemic attack 30 days to compare between groups the incidence of Stroke and transient ischemic attack
Acute renal failure (AKIN 1 or more) 30 days to compare between groups the incidence of Acute renal failure (AKIN 1 or more)
Incidence of severe adverse events 30 days to compare the incidence of severe adverse outcomes defined as mesenteric ischemia, digital ischemia, hyponatremia (Na\<130mEq/L), myocardial infarction or stroke
Acute myocardial infarction 30 days after randomization to compare between groups the incidence of acute myocardial infarction
Delirium 30 days to compare between groups the incidence of Delirium
Length of mechanical ventilation 30 days Length of mechanical ventilation