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Vasoplegic syndrome

Abdalsamih M Taeb, Michael H Hooper, Paul E Marik
Sepsis is a clinical syndrome that results from the dysregulated inflammatory response to infection that leads to organ dysfunction. The resulting losses to society in terms of financial burden, morbidity, and mortality are enormous. We provide a review of sepsis, its underlying pathophysiology, and guidance for diagnosis and management of this common disease. Current established treatments include appropriate antimicrobial agents to target the underlying infection, optimization of intravascular volume to improve stroke volume, vasopressors to counteract vasoplegic shock, and high-quality supportive care...
June 2017: Nutrition in Clinical Practice
Seyed Mohsen Mirhosseini, Ali Sanjari Moghaddam, Paritash Tahmaseb Pour, Ali Dabbagh
Postoperative vasoplegic syndrome (VS) is characterized by low systemic vascular resistance, normal or elevated cardiac output, and poor response to volume expansion. The incidence of VS after cardiac surgery requiring cardiopulmonary bypass is about 20%. Sometimes, VS becomes refractory and initial treatments do not work, rendering treatment a great challenge. In this study, we describe a young male patient with endocarditis undergoing tricuspid valve replacement. When being weaned off cardiopulmonary bypass, the patient experienced VS...
January 2017: Journal of Tehran Heart Center
Michael Mazzeffi, Benjamin Hammer, Edward Chen, Mark Caridi-Scheible, James Ramsay, Christopher Paciullo
BACKGROUND: Methylene blue (MB) has been used to treat refractory hypotension in a variety of settings. AIMS: We sought to determine whether MB improved blood pressure in postcardiopulmonary bypass (CPB) vasoplegic syndrome (VS) in a complex cardiac surgery population. Furthermore, to determine variables that predicted response to MB. SETTING AND DESIGN: This was conducted in a tertiary care medical center; this study was a retrospective cohort study...
April 2017: Annals of Cardiac Anaesthesia
Matthew A Warner, William J Mauermann, Sarah Armour, David W Barbara
No abstract text is available yet for this article.
February 22, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Tejesh C Anandaswamy, Geetha C Rajappa, Harish Krishnamachar
Vasoplegic syndrome is an unusual cause of refractory hypotension under general anesthesia. It is commonly described in the setting of cardiac surgery, but rarely seen in noncardiac setting. We describe successful management of vasoplegic syndrome during Whipple procedure with vasopressin infusion. A high index of suspicion and prompt treatment with vasopressin can be lifesaving in patients with risk factors for vasoplegic syndrome who present with severe refractory hypotension and who respond poorly to fluid administration and routine vasopressor infusion...
February 2017: Journal of Clinical Anesthesia
Pierre-Grégoire Guinot, Osama Abou-Arab, Mathieu Guilbart, Stéphane Bar, Elie Zogheib, Mona Daher, Patricia Besserve, Joseph Nader, Thierry Caus, Said Kamel, Hervé Dupont, Emmanuel Lorne
PURPOSE: To evaluate the ability of an algorithm based on dynamic arterial elastance to decrease the duration of norepinephrine treatment. METHODS: We performed a prospective, open-label, randomized study in patients requiring norepinephrine for vasoplegic syndrome after cardiac surgery with cardiopulmonary bypass. Patients were randomized to an algorithm-based intervention group or a control group. The primary outcome was the duration of norepinephrine treatment...
May 2017: Intensive Care Medicine
Brent T Boettcher, Harvey J Woehlck, Sarah E Reck, Johnny C Hong, Michael A Zimmerman, Joohyun Kim, M Tracy Zundel, Julie K Freed, Paul S Pagel
No abstract text is available yet for this article.
October 14, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Harvey J Woehlck, Brent T Boettcher, Kathryn K Lauer, David C Cronin, Johnny C Hong, Michael A Zimmerman, Joohyun Kim, Motaz Selim
Systemic vasoplegia is common in patients undergoing liver transplantation. In this report, we present a case in which treatment with conventional vasopressors caused peripheral arterial spasm, rendering arterial blood pressure monitoring impossible. Administration of methylene blue resolved the vasospasm; however, concern for toxic dose requirements limited its use. Hydroxocobalamin administration resolved the vasospasm and increased blood pressure without the potential adverse effects seen with methylene blue...
December 15, 2016: A & A Case Reports
Kelvin Henrique Vilalva, Fabrícia Teixeira Mumic, Marina Rodrigues Garcia Silveira, Enio David Mente, Paulo Roberto Barbosa Evora, Orlando Castro E Silva
A 57-year-old female patient received elective liver transplant due to nonalcoholic steatohepatitis complicated by hepatocellular carcinoma. Her preoperative Model for End-Stage Liver Disease score was 11. The total transplant ischemic time was 10 hours and 35 minutes, and the warm ischemic time was 35 minutes. Even with aggressive fluid overload and use of high concentrations of vasoactive amines, the patient developed possible primary graft dysfunction with poor response to fluids and vasopressor support, suggesting vasoplegic syndrome...
August 24, 2016: Experimental and Clinical Transplantation
Nelson Américo Hossne Junior, Matheus Miranda, Marcus Rodrigo Monteiro, João Nelson Rodrigues Branco, Guilherme Flora Vargas, José Osmar Medina de Abreu Pestana, Walter José Gomes
OBJECTIVE: Coronary artery bypass grafting is currently the best treatment for dialysis patients with multivessel coronary artery involvement. Vasoplegic syndrome of inflammatory etiology constitutes an important postoperative complication, with highly negative impact on prognosis. Considering that these patients have an intrinsic inflammatory response exacerbation, our goal was to evaluate the incidence and mortality of vasoplegic syndrome after myocardial revascularization in this group...
July 2015: Revista Brasileira de Cirurgia Cardiovascular
M Tracy Zundel, Brent T Boettcher, Joel T Feih, Nunzio Gaglianello, Paul S Pagel
No abstract text is available yet for this article.
December 2016: Journal of Cardiothoracic and Vascular Anesthesia
Paulo Roberto Barbosa Evora, Camila Bottura, Livia Arcêncio, Agnes Afrodite Sumarelli Albuquerque, Patrícia Martinez Évora, Alfredo José Rodrigues
PURPOSE: Cardiopulmonary bypass (CPB) procedures are thought to activate systemic inflammatory reaction syndrome (SIRS). Strategies to curb systemic inflammation have been previously described. However, none of them is adequate, since "curbing" the extent of the inflammatory response requires a multimodal approach. The aim of the present mini-review is to discuss the main key points about the main principles in cardiopulmonary bypass curbing inflammation. METHODS: No systematic literature search (MEDLINE) and extracted data from the accumulated experience of the authors...
2016: Acta Cirúrgica Brasileira
Kazuto Miyata, Sayaka Shigematsu
We report a case of vasoplegic syndrome (VS) after aortic valve replacement in a 65 year old male with aortic stenosis. The patient developed hypotension after separation from cardiopulmonary bypass (CPB). Transesophageal echocardiography revealed well-maintained cardiac function and normal prosthetic valve function. However, his cardiac index was 3.0 l x min(-1) x m(-2) and systemic vascular resistance index (SVRI) was 1100 dynes x sec(-1) x cm(-5) x m(-2). Diagnosing VS, norepinephrine administration was commenced...
January 2016: Masui. the Japanese Journal of Anesthesiology
Laura Hencken, Long To, Nancy Ly, Jeffrey A Morgan
Methylene blue (MB) has been used for additional blood pressure support in patients who develop severe, refractory vasoplegia; however, MB can induce serotonin syndrome, especially when used in conjunction with other serotonergic agents. We describe a case of serotonin syndrome in a patient who received MB for vasoplegic syndrome after left ventricular assist device implantation and discuss its presentation and management.
April 2016: Journal of Cardiac Surgery
A Belletti, M L Castro, S Silvetti, T Greco, G Biondi-Zoccai, L Pasin, A Zangrillo, G Landoni
BACKGROUND: Inotropes and vasopressors are frequently administered to critically ill patients in order to improve haemodynamic function and restore adequate organ perfusion. However, some studies have suggested a possible association between inotrope administration and increased mortality. We therefore performed a meta-analysis of randomized trials published in the last 20 yr to investigate the effect of these drugs on mortality. METHODS: BioMedCentral, PubMed, Embase and the Cochrane Central Register were searched (all updated April 8th, 2015)...
November 2015: British Journal of Anaesthesia
Chrystal Rutledge, Brian Brown, Kimberley Benner, Priya Prabhakaran, Leslie Hayes
Methylene blue (MB) is a medication commonly used to treat methemoglobinemia, reducing methemoglobin to hemoglobin. A novel use of MB, as detailed here, is in the treatment of refractory hypotension. A number of reports have detailed use of MB for this purpose in adults, but few data in pediatrics. A 22-month-old girl with Noonan syndrome, biventricular hypertrophic cardiomyopathy, and chronic positive pressure ventilation developed shock with tachycardia, hypotension, and fever after 3 days of diarrhea. She was critically ill, with warm extremities, bounding pulses, and brisk capillary refill...
October 2015: Pediatrics
John T Denny, Andrew T Burr, Fred Balzer, James T Tse, Julia E Denny, Darrick Chyu
Rabbit anti-thymocyte globulin (rATG) is an infusion of polyclonal rabbit-derived antibodies against human thymocyte markers, which can be used to prevent and treat acute rejection following organ transplantation. However, the product monograph issued by the manufacturer (Sanofi Canada) reports that serious immune-mediated reactions have been observed following the use of rATG, consisting of anaphylaxis or severe cytokine release syndrome (CRS), which is a form of vasoplegic syndrome (VS), in which distributive shock occurs refractory to norepinephrine (NE) and vasopressin (VP)...
May 2015: Experimental and Therapeutic Medicine
Paulo Roberto Barbosa Evora, Lafaiete Alves Junior, Cesar Augusto Ferreira, Antônio Carlos Menardi, Solange Bassetto, Alfredo José Rodrigues, Adilson Scorzoni Filho, Walter Vilella de Andrade Vicente
OBJECTIVE: This study was conducted to reassess the concepts established over the past 20 years, in particular in the last 5 years, about the use of methylene blue in the treatment of vasoplegic syndrome in cardiac surgery. METHODS: A wide literature review was carried out using the data extracted from: MEDLINE, SCOPUS and ISI WEB OF SCIENCE. RESULTS: The reassessed and reaffirmed concepts were 1) MB is safe in the recommended doses (the lethal dose is 40 mg/kg); 2) MB does not cause endothelial dysfunction; 3) The MB effect appears in cases of NO up-regulation; 4) MB is not a vasoconstrictor, by blocking the cGMP pathway it releases the cAMP pathway, facilitating the norepinephrine vasoconstrictor effect; 5) The most used dosage is 2 mg/kg as IV bolus, followed by the same continuous infusion because plasma concentrations sharply decrease in the first 40 minutes; and 6) There is a possible "window of opportunity" for MB's effectiveness...
January 2015: Revista Brasileira de Cirurgia Cardiovascular
Engy R Hanna, Jeffrey A Clark
Methylene blue, a drug used to treat vasoplegia and methemoglobinemia, also inhibits monoamine oxidase-A. When given in combination with serotonergic medications, methylene blue can lead to serotonin excess syndrome. Given the widespread use of serotonergic medication to treat depression, anesthesia providers should be aware of this potentially lethal interaction. Patients undergoing cardiopulmonary bypass for cardiac surgery are a specific population at risk for postbypass vasoplegic shock. The use of methylene blue to treat vasoplegia in this group of patients should be weighed in light of their current medications and potential drug interactions...
May 1, 2014: A & A Case Reports
M B Khosravi, S Milani, S Ghaffaripour, A Sahmeddini, M H Eghbal, S A Malek-Hosseini
A 55-year-old man with hepatitis B and hepatocellular carcinoma was treated with liver transplantation without veno-venous bypass. During the procedure his arterial blood pressure remained at 55/30 mm Hg and did not respond to increasing doses of norepinephrine. Vasoplegia was managed aggressively with the intravenous infusion of high doses of epinephrine.
2013: International Journal of Organ Transplantation Medicine
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