Epidemiology, risk factors and outcomes of norepinephrine use in cardiac surgery with cardiopulmonary bypass : a multicentric prospective study
Copyright © 2023 The Author(s). Published by Elsevier Masson SAS.. All rights reserved..
BACKGROUND: The present study was designed to describe the prevalence of norepinephrine use, the factors associated with its use, and the incidence of postoperative complications according to norepinephrine use, in patients undergoing cardiac surgery with cardiopulmonary bypass.
METHOD: We performed a prospective, multicenter, observational study in 4 University-affiliated medico-surgical cardiovascular units. We analyzed all patients treated with cardiac surgery after excluding pre-ECMO surgery, LVAD implantation, heart transplantation and intra-operative hemorrhage.
RESULTS: Of 9316 patients screened during the study period, 2862 were included and 2510 were analyzed. Among them, 1549 (61%) were treated with norepinephrine with a median maximal dose of 0.11 [0.06-0.2] μg.kg-1.min-1 and a median duration of 10 h [2-24]. Norepinephrine was most often started in the operating room before cardiopulmonary bypass. The multiple regression logistic analysis identified several modifiable (haematocrit, maintenance of beta-blocker, cardiopulmonary bypass time, glucose-insulin-potassium, Custodiol cardioplegia, Delnido cardioplegia, and fibrinogen transfusion) and non-modifiable factors (age, ASA score, chronic high blood pressure, coronary disease, dyslipidemia, right ventricular dysfunction, left ventricular dysfunction, active endocarditis, and valvular aortic surgery) associated with norepinephrine use. Mortality, morbidity (neurological and renal complications, death) and length of stay in the ICU were higher in patients treated with norepinephrine.
CONCLUSION: Norepinephrine is often used in cardiac surgical patients but for <24 h with a low dose. Many preoperative and surgical factors are associated with norepinephrine use. Patients supported by norepinephrine have a higher incidence of major postoperative events.
| Errataetall: |
CommentIn: Anaesth Crit Care Pain Med. 2023 Jun;42(3):101210. - PMID 36870666 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:42 |
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| Enthalten in: |
Anaesthesia, critical care & pain medicine - 42(2023), 3 vom: 30. Juni, Seite 101200 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Guinot, Pierre-Grégoire [VerfasserIn] |
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| Links: |
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| Themen: |
Acute kidney injury |
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| Anmerkungen: |
Date Completed 23.05.2023 Date Revised 24.05.2023 published: Print-Electronic CommentIn: Anaesth Crit Care Pain Med. 2023 Jun;42(3):101210. - PMID 36870666 Citation Status MEDLINE |
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| doi: |
10.1016/j.accpm.2023.101200 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
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| 100 | 1 | |a Guinot, Pierre-Grégoire |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Epidemiology, risk factors and outcomes of norepinephrine use in cardiac surgery with cardiopulmonary bypass |b a multicentric prospective study |
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| 500 | |a CommentIn: Anaesth Crit Care Pain Med. 2023 Jun;42(3):101210. - PMID 36870666 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Author(s). Published by Elsevier Masson SAS.. All rights reserved. | ||
| 520 | |a BACKGROUND: The present study was designed to describe the prevalence of norepinephrine use, the factors associated with its use, and the incidence of postoperative complications according to norepinephrine use, in patients undergoing cardiac surgery with cardiopulmonary bypass | ||
| 520 | |a METHOD: We performed a prospective, multicenter, observational study in 4 University-affiliated medico-surgical cardiovascular units. We analyzed all patients treated with cardiac surgery after excluding pre-ECMO surgery, LVAD implantation, heart transplantation and intra-operative hemorrhage | ||
| 520 | |a RESULTS: Of 9316 patients screened during the study period, 2862 were included and 2510 were analyzed. Among them, 1549 (61%) were treated with norepinephrine with a median maximal dose of 0.11 [0.06-0.2] μg.kg-1.min-1 and a median duration of 10 h [2-24]. Norepinephrine was most often started in the operating room before cardiopulmonary bypass. The multiple regression logistic analysis identified several modifiable (haematocrit, maintenance of beta-blocker, cardiopulmonary bypass time, glucose-insulin-potassium, Custodiol cardioplegia, Delnido cardioplegia, and fibrinogen transfusion) and non-modifiable factors (age, ASA score, chronic high blood pressure, coronary disease, dyslipidemia, right ventricular dysfunction, left ventricular dysfunction, active endocarditis, and valvular aortic surgery) associated with norepinephrine use. Mortality, morbidity (neurological and renal complications, death) and length of stay in the ICU were higher in patients treated with norepinephrine | ||
| 520 | |a CONCLUSION: Norepinephrine is often used in cardiac surgical patients but for <24 h with a low dose. Many preoperative and surgical factors are associated with norepinephrine use. Patients supported by norepinephrine have a higher incidence of major postoperative events | ||
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| 700 | 1 | |a Constandache, Tiberiu |e investigator |4 oth | |
| 700 | 1 | |a Grosjean, Sandrine |e investigator |4 oth | |
| 700 | 1 | |a Radhouani, Mohamed |e investigator |4 oth | |
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