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Correspondence

Reply

Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, Victoria 3084, Australia

(Email: rinaldo.bellomo{at}austin.org.au).

To the Editor:

We read with interest the letter by Dr Augoustides [1] and his mention of prostaglandin inhibition [2] as a potential strategy to treat vasoplegia after cardiac surgery.

We consider it logical to believe that prostaglandins might participate in the inflammatory and vasodilating changes seen with cardiopulmonary bypass, and it is theoretically possible that their inhibition would improve blood pressure. However, we would like to point out several aspects of this study supporting such treatment. First, the trial was not double-blinded and was thus open to bias. Second, it was very small and thus at great risk of type I error. Third, the mean arterial pressure during bypass was tolerated at extraordinarily low levels in the control group. Finally, the intervention was administered before and during bypass, whereas our review was focused on post-bypass treatment [3]. Given these features and the risks of nonsteroidal therapy [4], we would invite great caution with considering such treatment on the available data, and given the intraoperative use, we could not justify the inclusion of this study in our review.

	References

Top References

 

1. Augoustides JGT. Management of vasoplegia after cardiopulmonary bypass: role of prostaglandin inhibition (letter) Ann Thorac Surg 2007;84:1796.[Free Full Text]
2. Takewa Y, Seki T, Tatsumi E, Taenaka Y, Takano H. Prostaglandin synthesis inhibitor improves hypotension during normothermic cardiopulmonary bypass ASAIO J 2001;47:673-676.[Medline]
3. Egi M, Bellomo R, Lnagenberg C, et al. Selecting a vasopressor drug for vasoplegic shock after adult cardiac surgery: a systematic literature review Ann Thorac Surg 2007;83:715-723.[Abstract/Free Full Text]
4. Kinights KM, Tsoutsikos P, Miners JO. Novel mechanisms of nonsteroidal anit-inflammatory drug induced renal toxicity Expert Opin Drug Metab Toxicol 2005;1:399-408.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Egi, M. Articles by Bellomo, R. Search for Related Content PubMed Articles by Egi, M. Articles by Bellomo, R. Related Collections Cardiac - pharmacology Related Article