Vasoplegic syndrome

Vasoplegic syndrome (VPS) is a postperfusion syndrome characterized by low systemic vascular resistance and a high cardiac output.

Causes

VPS occurs more frequently after on pump CABG surgery versus off pump CABG surgery.[1] Hypothermia during surgery may also increase ones risk of developing VPS post operatively.[2]

Diagnosis

Definition

Vasoplegic syndrome is defined as low systemic vascular resistance (SVR index <1,600 dyn∙sec/cm5/m2) and high cardiac output (cardiac index >2.5 L/min/m2) within the first 4 postoperative hours.[3]

Treatment

Gross pathology of a normal brain and a brain of a patient treated with methylene blue before death.

There is some evidence to support the use of methylene blue in the treatment of this condition.[4][5]

Epidemiology

One case series reports a rate of 1 in 120 cases.[6]

References

  1. ↑ Sun X, Zhang L, Hill PC, et al. (October 2008). "Is incidence of postoperative vasoplegic syndrome different between off-pump and on-pump coronary artery bypass grafting surgery?". Eur J Cardiothorac Surg. 34 (4): 820–5. doi:10.1016/j.ejcts.2008.07.012. PMID 18715792.
  2. ↑ Xu J, Long C, Qi R, Xie L, Shi S, Zhang Y (January 2002). "[Study of mechanism of vasoplegic syndrome for open heart surgery]". Zhonghua Yi Xue Za Zhi (in Chinese). 82 (2): 127–30. PMID 11953144.
  3. ↑ Iribarren, J.; Jimenez, J.; Brouard, M.; Lorenzo, J.; Perez, R.; Lorente, L.; Nuñez, C.; Lorenzo, L.; Henry, C.; Martinez, R.; Mora, M. (2007-03-22). "Critical Care | Full text | Vasoplegic syndrome after cardiopulmonary bypass surgery – associated factors and clinical outcomes: a nested case-control study". Critical Care. 11 (2): P254. doi:10.1186/cc5414. PMC 4095307.
  4. ↑ "BestBets: Is Methylene Blue of benefit in treating adult patients who develop vasoplegic syndrome during Cardiac Surgery".
  5. ↑ Stawicki SP, Sims C, Sarani B, Grossman MD, Gracias VH (May 2008). "Methylene blue and vasoplegia: who, when, and how?". Mini Rev Med Chem. 8 (5): 472–90. doi:10.2174/138955708784223477. PMID 18473936.
  6. ↑ Gomes WJ, Carvalho AC, Palma JH, Gonçalves Júnior I, Buffolo E (1994). "[Vasoplegic syndrome: a new dilemma]". Rev Assoc Med Bras. 40 (4): 304. PMID 7633508.
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