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Association Between Changes in Norepinephrine Infusion Rate and Urinary Oxygen Tension After Cardiac Surgery

  • Johnny Vogiatjis
    Affiliations
    Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
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  • Khin M. Noe
    Affiliations
    Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia

    Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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  • Andrea Don
    Affiliations
    Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
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  • Andrew D. Cochrane
    Affiliations
    Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia

    Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia
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  • Michael Z.L. Zhu
    Affiliations
    Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia

    Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia

    Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia
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  • Julian A. Smith
    Affiliations
    Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia

    Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia
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  • Jennifer P. Ngo
    Affiliations
    Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia

    Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
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  • Andrew Martin
    Affiliations
    Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia

    Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia

    Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia
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  • Amanda G. Thrift
    Affiliations
    Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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  • Rinaldo Bellomo
    Affiliations
    Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia

    Department of Critical Care, University of Melbourne, Melbourne, Australia

    Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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  • Roger G. Evans
    Correspondence
    Address correspondence to Roger Evans, PhD, Department of Physiology, 26 Innovation Walk, Monash University, Victoria 3800, Australia.
    Affiliations
    Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia

    Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia

    Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Published:November 10, 2022DOI:https://doi.org/10.1053/j.jvca.2022.11.008

      Objectives

      To 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.

      Design

      Single center, prospective observational study.

      Setting

      Surgical intensive care unit (ICU).

      Participants

      A nonconsecutive sample of 93 patients recovering from on-pump cardiac surgery.

      Measurements and Main Results

      In 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).

      Conclusions

      In 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.

      Key Words

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