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To the Editors:

As an RN at Columbia Presbyterian’s cardiothoracic intensive care unit, I read with great interest the article "Vasopressin in the Cardiac Surgery Intensive Care Unit" (July 2002:326–330). We are privileged to be working with Dr Landry as well as with the cardiac surgeons who have been applying his groundbreaking vasopressin research in cardiac surgery patients.

Our nurses are quite familiar with the use of vasopressin infusions in the setting of shock, and it is one of the mainstays of pharmacologic therapy in our unit. I must therefore take immediate issue with your dosing recommendations and point out the dangerous inconsistencies in the tables and the text of the article. There are 2 instances where dosing is correctly described, ie, on page 329, "Research to date indicates that a dosing range of 0.01 up to 0.1 U/min is most effective in patients with vasodilatory shock without causing any adverse effects." This is repeated in the summary on page 330.

Unfortunately, massive overdoses are sanctioned on page 327: "... whereas the vasoconstrictive effects require up to 1 U every 5 minutes by continuous intravenous infusion." Worse still, the table on page 329 lists the continuous infusion rate for vasodilatory shock after cardiopulmonary bypass as 0.01 to 1.0 U/min, with the latter exceeding maximum dose by a factor of 10. These errors are then reinforced in question 8 of the continuing education test for this article.

In refractory shock, vasopressin drips running faster than 6 U/hr (presumably along with other vasoconstricting agents) will not be effective and will present a tremendous risk of severe tissue ischemia.

Susan DeLisle, RN, CCRN
New York, NY

The authors reply

The authors would like to extend many thanks to Susan DeLisle for her critical review of our article. Based on the data, largely from Columbia Pres-byterian, we absolutely agree with the dosing regimen of 0.01 to 0.1 U/min. The table and question in the article obviously are not correct, and we apologize for the error. [See Corrections below regarding this article.] As vasopressin has proven to be a safe and effective agent in our postcardiotomy patients, this article was born out of a single critical care nurse’s curiosity with regard to cardiovascular pharmacology. The end result was a tremendous learning experience for both our outstanding nursing staff and cardiac surgeons. From all of us at the University of Colorado Health Sciences Center, we congratulate you on your clinical contributions and anxiously await further ground-breaking research and recommendations.

Tracy N. Albright, RN, CCRN, Michael A. Zimmerman, MD and Craig H. Selzman, MD

This Article Full Text (PDF) Respond to This Article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by DeLisle, S. Articles by Selzman, C. H. Search for Related Content PubMed PubMed Citation Articles by DeLisle, S. Articles by Selzman, C. H.