<abstract xmlns="http://www.w3.org/1999/xhtml">

<p><bold>Background:</bold> The oral vasopressin-2 receptor antagonist tolvaptan causes aquaresis, and its effect on heart failure is proven. However, it is not recommended in patients who are unable to appropriately respond to thirst because of possible severe hypernatremia. Aim: To assess the safety and efficacy of tolvaptan treatment via nasogastric tube in patients who are unable to respond to thirst by fluid ingestion. <bold>Methods:</bold> We analyzed 70 consecutive patients with severe congestive heart failure (CHF) who were resistant to loop diuretics and treated with tolvaptan. From the 70 patients, 12 required endotracheal intubation under sedation (Group Tube; GT) and 58 did not (Group Oral; GO). We administered tolvaptan orally in GO; however, in GT, we had to administer tolvaptan via nasogastric tube to achieve pulmonary decongestion quickly. In GT, serum sodium level was monitored closely, and intravenous fluid infusion volume was controlled in the intensive care unit (ICU). Outcomes, including safety and efficacy parameters, were evaluated. <bold>Results:</bold> In both groups, tolvaptan treatment did not develop a significant rise in serum sodium level compared with baseline, and the incidence of worsening renal failure was comparable, despite greater net fluid loss and higher doses of loop diuretics used in patients of GT compared to GO. In GT, all patients achieved pulmonary decongestion and were weaned from mechanical ventilation. <bold>Conclusions:</bold> In sedated patients with severe CHF who are unable to respond to thirst by fluid ingestion, tolvaptan can be used without clinically significant hypernatremia under close monitoring in the ICU.</p>
</abstract>

Background: The oral vasopressin-2 receptor antagonist tolvaptan causes aquaresis, and its effect on heart failure is proven. However, it is not recommended in patients who are unable to appropriately respond to thirst because of possible severe hypernatremia. Aim: To assess the safety and efficacy of tolvaptan treatment via nasogastric tube in patients who are unable to respond to thirst by fluid ingestion. Methods: We analyzed 70 consecutive patients with severe congestive heart failure (CHF) who were resistant to loop diuretics and treated with tolvaptan. From the 70 patients, 12 required endotracheal intubation under sedation (Group Tube; GT) and 58 did not (Group Oral; GO). We administered tolvaptan orally in GO; however, in GT, we had to administer tolvaptan via nasogastric tube to achieve pulmonary decongestion quickly. In GT, serum sodium level was monitored closely, and intravenous fluid infusion volume was controlled in the intensive care unit (ICU). Outcomes, including safety and efficacy parameters, were evaluated. Results: In both groups, tolvaptan treatment did not develop a significant rise in serum sodium level compared with baseline, and the incidence of worsening renal failure was comparable, despite greater net fluid loss and higher doses of loop diuretics used in patients of GT compared to GO. In GT, all patients achieved pulmonary decongestion and were weaned from mechanical ventilation. Conclusions: In sedated patients with severe CHF who are unable to respond to thirst by fluid ingestion, tolvaptan can be used without clinically significant hypernatremia under close monitoring in the ICU.

Possible Option for Treatment of Severe Congestive Heart Failure Under Mechanical Ventilation Using Tolvaptan via Nasogastric Tube: A Single-Center Analysis

Department of Cardiovascular Medicine, International University of Health and Welfare Hospital

Journal of Cardiovascular Emergencies

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Background: The oral vasopressin-2 receptor antagonist tolvaptan causes aquaresis, and its effect on heart failure is proven. However, it is not recommended in...

Possible Option for Treatment of Severe Congestive Heart Failure Under Mechanical Ventilation Using Tolvaptan via Nasogastric Tube: A Single-Center Analysis

Article Category: ORIGINAL RESEARCH

Published Online: Dec 30, 2021

Page range: 107 - 115

Received: Sep 29, 2021

Accepted: Oct 21, 2021

DOI: https://doi.org/10.2478/jce-2021-0016

Keywords
tolvaptan, diuretics, hypernatremia, nasogastric tube, severe congestive heart failure

© 2021 Morihiko Takeda., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Possible Option for Treatment of Severe Congestive Heart Failure Under Mechanical Ventilation Using Tolvaptan via Nasogastric Tube: A Single-Center Analysis

Article Category: ORIGINAL RESEARCH

Published Online: Dec 30, 2021

Page range: 107 - 115

Received: Sep 29, 2021

Accepted: Oct 21, 2021

DOI: https://doi.org/10.2478/jce-2021-0016

Keywordstolvaptan, diuretics, hypernatremia, nasogastric tube, severe congestive heart failure

© 2021 Morihiko Takeda., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Keywords
tolvaptan, diuretics, hypernatremia, nasogastric tube, severe congestive heart failure