Incidence of infection in patients treated with vasopressin or noradrenalin in shock after cardiac surgery: a double-blind, controlled and randomized trial

Abstract

In this project we intend to demonstrate that the use of arginine vasopressin would not only be more effective on the treatment of vasoplegic syndrome than conventional catecholamine vasopressors (especially norepinephrine), but also decrease the incidence of postoperative infections in patients undergoing cardiac surgery under cardiopulmonary bypass. We believe that this improvement in patients' outcome is due to the fact that vasopressin interfere less in the immune system as compared with norepinephrine. Besides reducing the immune response in patients already immunosuppressed due to the use of a prophylactic therapy with corticosteroids in cardiac surgery, norepinephrine is also associated with the stimulation of bacterial growth and the increase of factors related to bacterial virulence. We expect that vasopressin does not present those negative effects on the immune system and promotes benefic effects in specific organs which may lead to a decrease in postoperative length of stay, and, therefore, a decrease in the incidence of nosocomial infections. The aim of this study is to compare the incidence of infection during the hospital stay in patients treated with vasopressin as a single vasopressor agent with those treated with norepinephrine in the management of vasodilatory shock after cardiac surgery. In this unicentric, prospective, controlled, randomized and double-blind trial, the primary end point will be the incidence of infection 28 days after the start of infusions. Furthermore, the two groups will be compared regarding the most prevalent pathogens and the incidence of mortality caused by infection during 28 consecutive days. (AU)