• Johnny Vogiatjis, Khin M Noe, Andrea Don, Andrew D Cochrane, Michael Z L Zhu, Julian A Smith, Jennifer P Ngo, Andrew Martin, Amanda G Thrift, Rinaldo Bellomo, and Roger G Evans.
• Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia.
• J. Cardiothorac. Vasc. Anesth. 2023 Feb 1; 37 (2): 237245237-245.

ObjectivesTo determine if the administration of norepinephrine to patients recovering from on-pump cardiac surgery is associated with changes in urinary oxygen tension (PO2), an indirect index of renal medullary oxygenation.DesignSingle center, prospective observational study.SettingSurgical intensive care unit (ICU).ParticipantsA nonconsecutive sample of 93 patients recovering from on-pump cardiac surgery.Measurements And Main ResultsIn the ICU, norepinephrine was the most commonly used vasopressor agent (90% of patients, 84/93), with fewer patients receiving epinephrine (48%, 45/93) or vasopressin (4%, 4/93). During the 30-to-60-minute period after increasing the infused dose of norepinephrine (n = 89 instances), urinary PO2 decreased by (least squares mean ± SEM) 1.8 ± 0.5 mmHg from its baseline level of 25.1 ± 1.1 mmHg. Conversely, during the 30-to-60-minute period after the dose of norepinephrine was decreased (n = 134 instances), urinary PO2 increased by 2.6 ± 0.5 mmHg from its baseline level of 22.7 ± 1.2 mmHg. No significant change in urinary PO2 was detected when the dose of epinephrine was decreased (n = 21). There were insufficient observations to assess the effects of increasing the dose of epinephrine (n = 11) or of changing the dose of vasopressin (n <4).ConclusionsIn patients recovering from on-pump cardiac surgery, changes in norepinephrine dose are associated with reciprocal changes in urinary PO2, potentially reflecting an effect of norepinephrine on renal medullary oxygenation.Copyright © 2022 Elsevier Inc. All rights reserved.

12 keywords...

hide…