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Vasoplegic syndrome is a common complication after cardiac surgery. Low dose vasopressin can up-regulate blood pressure and improve clinical outcomes compared with norepinephrine (mainly acute kidney injury Anesthesiology 2017; 126:85-93). Pituitrin is used as a substitute for vasopressin in our center, which contains both vasopressin and oxytocin. Oxytocin may alleviate inflammatory process-associated kidney injury (Peptides 2006;27:2249-57). Therefore, the investigators hypothesize Pituitrin may be preferable to norepinephrine in the renal protection of patients with vasoplegic syndrome after cardiac surgery. Moreover, the serum levels of vasopressin, catecholamine, corticosteroid and corticotropin-releasing hormone will be measured.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Pituitrin arm | Experimental | To begin with 0.02 U/min to maintain mean arterial pressure(MAP) higher than 65 mmHg. |
|
| Norepinephrine arm | Experimental | To begin with 0.04 μg/kg.min to maintain mean arterial pressure(MAP) higher than 65 mmHg. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Pituitrin infusion | Drug | To begin with 0.02 U/min to maintain mean arterial pressure(MAP) higher than 65 mmHg. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Rate of in-hospital acute renal injury | Acute renal injury (AKI) is defined as any of the following: (1) increase in serum creatinine (SCr) by ≥ 26.5lmol/l in 48 hours; (2) increase in SCr to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or (3) urine output < 0.5 ml/kg/h for 6 hours (urine output is only assessed when the CRRT machine is absent or with a fluid removal rate of 0 ml/h). | 30 days |
| Measure | Description | Time Frame |
|---|---|---|
| In-hospital mortality | All-cause mortality | 30 days |
| Rate of new arrhythmias | Rate of new arrhythmias after cardiac surgery | 30 days |
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Inclusion Criteria:
1. Patients diagnosed as vasoplegic syndrome(defined as mean arterial pressure less than 65 mmHg resistant to fluid challenge and cardiac index greater than 2.2 L/min · m2) within 24 hours after cardiac surgery.
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Hong Wang, PhD., MD. | Contact | 86 15010516438 | 914286855@qq.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University | Recruiting | Beijing | Beijing Municipality | 100029 | China |
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| ID | Term |
|---|---|
| D056987 | Vasoplegia |
| ID | Term |
|---|---|
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
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| Norepinephrine infusion | Drug | To begin with 0.04 μg/kg.min to maintain mean arterial pressure(MAP) higher than 65 mmHg. |
|
| Hormone levels | Serum hormone levels after cardiac surgery, including vasopressin, catecholamine, corticosteroid and corticotropin-releasing hormone | 30 days |
| Rate of ECMO or LVAD support | Receiving extracorporeal membrane oxygenation (ECMO) or left ventricle assist device (LVAD) support | 30 days |
| Duration on ventilator support | Duration on ventilator support after cardiac surgery | 30 days |
| ICU length of stay | ICU length of stay | 30 days |
| Hospital length of stay after cardiac surgery | Hospital length of stay after cardiac surgery | 30 days |
| D013568 | Pathological Conditions, Signs and Symptoms |