Correspondence  |   January 2018
Vasopressin versus Norepinephrine after Cardiopulmonary Bypass
Author Notes
  • Johns Hopkins University School of Medicine, Baltimore, Maryland (N.F.). nfaraday@jhmi.edu
  • (Accepted for publication September 27, 2017.)
    (Accepted for publication September 27, 2017.)×
Article Information
Correspondence
Correspondence   |   January 2018
Vasopressin versus Norepinephrine after Cardiopulmonary Bypass
Anesthesiology 1 2018, Vol.128, 229-230. doi:10.1097/ALN.0000000000001956
Anesthesiology 1 2018, Vol.128, 229-230. doi:10.1097/ALN.0000000000001956
We read with great interest the paper by Hajjar et al., “Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery: The VANCS Randomized Controlled Trial,” and the accompanying editorial.1,2  There are a number of limitations inadequately addressed by the authors and in the editorial that limit the generalizability of VANCS findings to clinical practice.
First and most importantly, the VANCS treatment protocol used doses of vasopressin and norepinephrine that are not equivalent. Vasopressin was dosed at 0.01 to 0.06 U/min, which is similar to dosing in common clinical practice and to the regimens used in large randomized controlled trials of vasopressin versus norepinephrine in sepsis (Vasopressin and Septic Shock Trial [VASST] and the Vasopressin vs. Norepinephrine as Initial Therapy in Septic Shock [VANISH]).3,4  On the other hand, norepinephrine was dosed at 10 to 60 μg/min (~0.14 to 0.86 μg · kg–1 · min–1), which is approximately five times higher than the dose typically used following cardiopulmonary bypass at our center and many others. This dose also far exceeds that used in VASST (5 to 15 μg/min) and VANISH (maximum of 12μg/min). Using lower doses, neither VASST nor VANISH found significant differences in acute kidney injury or other outcomes between vasopressors.
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