Terlipressin infusion versus norepinephrine infusion for management of postcoronary artery bypass grafting refractory hypotension: a comparative study

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Abstract

Objective
The aim was to evaluate outcome of diabetic patients who developed refractory hypotension after coronary artery bypass grafting (CABG) surgery on using terlipressin (TP) versus norepinephrine (NE) infusions.
Patients and methods
A total of 44 patients were divided into two groups: group NE received NE infusion (0.1 µg/kg/min) and group TP received TP infusion (2 µg/kg/h). On cardiopulmonary bypass weaning (0 h), hemodynamic parameters, levels of blood glucose (BG) and blood lactate, serum creatine kinase-MB, and cardiac troponin T were determined. If systolic less than 90 mmHg and/or mean arterial pressure (MAP) less than 60 mmHg persisted after 5 min of adequate volume resuscitation, vasopressor infusions were started and hemodynamic parameters were recorded. If initial doses failed to achieve adequate hemodynamic stability at 10 min, the dose was increased. Postoperative levels of studied parameters were estimated.
Results
NE significantly whereas TP nonsignificantly increased heart rate. Both infusions induced persistently higher MAP at 10 min, 30 min, and 4 h compared with 0 h, with nonsignificantly higher MAP with TP versus NE. Both infusions increased BG levels compared with 0 h estimates, with significant difference with NE. At 24 h, serum creatine kinase-MB levels were significantly lower with TP than NE, whereas serum cardiac troponin T levels showed nonsignificant difference. Lactate clearance rate was significantly higher with TP.
Conclusion
Vasopressor infusion improved hemodynamics. TP did well than NE with significant increase of blood pressure measures but minimized cardiac ischemic risk and the increase of BG and blood lactate levels.

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