Factores implicados en el desarrollo de vasoplejía tras cirugía cardiaca con circulación extracorpórea. Estudio prospectivo observacional

Bruce, M D; Sancho, Carmen Gomar; Holguera, J.C.; Español, Episcopado

doi:10.1016/j.redar.2013.11.015

Cited by 11 publications

(10 citation statements)

References 17 publications

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“…The most important risk factors are blood transfusion, CPB, transplantation, burns, trauma, pancreatitis, sepsis, and drugs (Table 2). 3,5,8,[11][12][13][14][15][16]…”

Section: Perioperative Risk Factors In Vasoplegic Syndromementioning

confidence: 99%

“…[6][7][8] Risk factors for VS during CPB include male gender, higher body mass index, elderly (>65 years), anemia, high EuroSCORE, ejection fraction (EF) <35%, myocardial ischemia, diabetes mellitus, dialysis-dependent renal failure, LVAD use, prolonged of CPB, hypotension soon after the onset of CPB, angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) use, infected endocarditis, and the use of inodilators (milrinone, dobutamine, levosimendan) in the perioperative period (Table 3). 8,[11][12][13][14][15][16] The cardiac anaesthesiologist should evaluate essential risk factors that worsen VS, such as acid-base and fluidelectrolyte disorders, hypothermia, and hypoxia before surgery. Cardiovascular surgery requires a multidisciplinary and comprehensive assessment and management approach.…”

Section: A) Blood Transfusionmentioning

confidence: 99%

“…[6][7][8][10][11][12] Thus, VS is associated with increased morbidity in the perioperative period. 7,8,[12][13][14][15][16] It is challenging for an anaesthesiologist to consider this syndrome's diagnosis and manage its treatment.…”

Section: Introductionmentioning

confidence: 99%

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Untitled

2023

Turk J Anaesthesiol Reanim

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Main Points• Vasoplegic syndrome (VS) is defined as low systemic vascular resistance, normal or high cardiac output, and resistant hypotension unresponsive to vasopressor agents and intravenous (IV) volume.• VS is an essential complication in cardiac and transplantation surgery, burns, trauma, pancreatitis, and sepsis.• VS is related to highly increased perioperative morbidity and mortality.• Overproduction of iNO, activation of ATP-dependent K + channels and NF-κB, and vasopressin receptor 1A (V 1 A-receptor) downregulation are responsible for the pathogenesis of VS.• Rapid identification and diagnosis of at-risk patients should implement an optimal therapeutic approach.• Treatment strategies involve IV administration of volume and inotropes, vasopressin, methylene blue, angiotensin II, corticosteroids, hydroxocobalamin, Ca ++ vitamin C, and thiamine, and should also restore vascular tone and improve vasoplegia.

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“…The most important risk factors are blood transfusion, CPB, transplantation, burns, trauma, pancreatitis, sepsis, and drugs (Table 2). 3,5,8,[11][12][13][14][15][16]…”

Section: Perioperative Risk Factors In Vasoplegic Syndromementioning

confidence: 99%

Section: A) Blood Transfusionmentioning

confidence: 99%

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Untitled

2023

Turk J Anaesthesiol Reanim

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“…7 Busse et al 8 have defined the VPS when shock occurs within 24 h of CPB in the setting of a CI is greater than 2.2 L/kg/m 2 and SVR less than 800 dyn/s/cm 5 . Duran et al 9 have defined VPS as MAP < 50, requiring NE > 0.08 Ug/kg/min for hypotension in the absence of low cardiac output state. 9 In 2017, Tsiouris et al have defined VPS as hypotension with low SVR (<800 dyn/s/cm) and preserved CI (>2.5).…”

Section: Benchmark Standards For Defining Vpsmentioning

confidence: 99%

“…Duran et al 9 have defined VPS as MAP < 50, requiring NE > 0.08 Ug/kg/min for hypotension in the absence of low cardiac output state. 9 In 2017, Tsiouris et al have defined VPS as hypotension with low SVR (<800 dyn/s/cm) and preserved CI (>2.5). More specifically they have categorized vasoplegia as: mild: (1) MAP 50-60 mmHg, requiring administration of one vasopressor, moderate: MAP 50-60 mmHg, and requiring administration of two or more vasopressors; or MAP < 50 mmHg and administration of one vasopressor; and severe: MAP < 50 mmHg, and requiring administration of two or more vasopressors.…”

Section: Benchmark Standards For Defining Vpsmentioning

confidence: 99%

Vasoplegic syndrome after cardiovascular surgery: A review of pathophysiology and outcome‐oriented therapeutic management

Datt

Wadhhwa

Sharma

et al. 2021

Journal of Cardiac Surgery

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Background: Vasoplegic syndrome (VPS) is defined as systemic hypotension due to profound vasodilatation and loss of systemic vascular resistance (SVR), despite normal or increased cardiac index, and characterized by inadequate response to standard doses of vasopressors, and increased morbidity and mortality. It occurs in 9%-44% of cardiac surgery patients after cardiopulmonary bypass (CPB). The underlying pathophysiology following CPB consists of resistance to vasopressors (inactivation of Ca 2+ voltage gated channels) on the one hand and excessive activation of vasodilators (SIRS, iNOS, and low AVP) on the other. Use of angiotensinconverting enzyme inhibitor (ACE-I), calcium channel blockers, amiodarone, heparin, low cardiac reserve (EF < 35%), symptomatic congestive heart failure, and diabetes mellitus are the perioperative risk factors for VPS after cardiac surgery in adults. Till date, there is no consensus about the outcome-oriented therapeutic management of VPS. Vasopressors such as norepinephrine (NE; 0.025-0.2 µg/kg/min) and vasopressin (0.06 U/min or 6 U/h median dose) are the first choice for the treatment. The adjuvant therapy (hydrocortisone, calcium, vitamin C, and thiamine) and rescue therapy (methylene blue [MB] and hydroxocobalamin) are also considered when perfusion goals (meanarterial pressure [MAP] > 60-70 mmHg) are not achieved with nor-epinephrine and/or vasopressin.Aims: The aims of this systematic review are to collect all the clinically relevant data to describe the VPS, its potential risk factors, pathophysiology after CPB, and to assess the efficacy, safety, and outcome of the therapeutic management with catecholamine and non-catecholamine vasopressors employed for refractory vasoplegia after cardiac surgery. Also, to elucidate the current and practical approach for management of VPS after cardiac surgery.Material and Methods: "PubMed," "Google," and "Medline" weresearched, and over 150 recent relevant articles including RCTs, clinical studies, meta-analysis, reviews, case reports, case series and Cochrane data were analyzed for this systematic review. The filter was applied specificallyusing key words like VPS after cardiac surgery, perioperative VPS following CPB, morbidity, and mortality in VPS after cardiac surgery, vasopressors for VPS that improve outcomes, VPS after valve surgery, VPS after CABG surgery, VPS following complex congenital cardiac anomalies corrective surgery, rescue therapy for VPS, adjuvant therapy for VPS, definition of VPS, outcome in VPS after cardiac surgery, etiopathology of VPS following CPB. This review did not require any ethical approval or consent from the patients.Results: Despite the recent advances in therapy, the mortality remains as high as 30%-50%. NE has been recommended the most frequent used vasopressor for VPS.It restores and maintain the MAP and provides the outcome benefits. Vasopressin rescue therapy is an alternative approach, if catecholamines and fluid infusions fail to improve hemodynamics. It effectively increases vascular tone and lowe...

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