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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