Vasoplegia: Mechanism and Management Following Cardiopulmonary Bypass

Overview

Journal Eurasian J Med

Publisher Aves

Specialty General Medicine

Date 2022 Mar 21

PMID 35307639

Authors

Rizal Muhammad

Budi Baktijasa Dharmadjati

Eka Prasetya Budi Mulia

Dita Aulia Rachmi

Affiliations

Soon will be listed here.

Abstract

Vasoplegia is defined by hypotension and low systemic vascular resistance despite the normal or elevated cardiac index, a complication frequently following cardiac surgery, carrying high morbidity and mortality rate. Vasoplegia is related with a profound systemic inflammatory response and is mainly mediated by cellular hyperpolarization, a relative vasopressin deficiency, and high levels of inducible nitric oxide, following cardiopulmonary bypass. Cardiopulmonary bypass is a distinct precipitant of vasoplegia, generally due to its association with nitric oxide production and severe vasopressin depletion. Postoperative vasoplegia is usually managed with vasopressors, of which catecholamines are the traditional agents of choice. Recent studies promote the use of non-catecholamine vasopressor (vasopressin) in restoring systemic vascular resistance. Alternative agents are also able to restore vascular tone and improve vasoplegia, including methylene blue, angiotensin II, hydroxocobalamin, and ascorbic acid; however, their effect on patient outcomes is still unclear .

Citing Articles

The Use of Methylene Blue in Conjunction With Hydroxocobalamin and Multiple Pressors to Treat Severe Vasoplegia in a Patient Due to Calcium Channel Blocker Toxicity: A Case Report.

Hacker A, Irvine D, Gross M, Thornton I, Marin D Cureus. 2024; 16(2):e53778.

PMID: 38465145 PMC: 10923546. DOI: 10.7759/cureus.53778.

Severe Refractory Vasoplegic Shock Syndrome after OPCABG Successfully Treated with Hydroxycobalamin: A Case Report and Review of the Literature.

Bacchi B, Cabrucci F, Chiarello B, Dokollari A, Bonacchi M J Clin Med. 2024; 13(1).

PMID: 38202178 PMC: 10779867. DOI: 10.3390/jcm13010169.

Vasoplegia: A Review.

Ratnani I, Ochani R, Shaikh A, Jatoi H Methodist Debakey Cardiovasc J. 2023; 19(4):38-47.

PMID: 37547893 PMC: 10402787. DOI: 10.14797/mdcvj.1245.

Hydroxocobalamin as Rescue Therapy in a Patient With Refractory Amlodipine-Induced Vasoplegia.

Ayasa L, Azar J, Odeh A, Ayyad M, Shbaita S, Zidan T Cureus. 2023; 15(5):e38400.

PMID: 37265888 PMC: 10231868. DOI: 10.7759/cureus.38400.

Hemoadsorption in Complex Cardiac Surgery-A Single Center Experience.

Manohar M, Jawali V, Neginahal S, Gt S, Muniraj G, Chakravarthy M J Clin Med. 2022; 11(23).

PMID: 36498579 PMC: 9735704. DOI: 10.3390/jcm11237005.

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