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Vasoplegia

Condition of low SYSTEMIC VASCULAR RESISTANCE that develops secondary to other conditions such as ANAPHYLAXIS; SEPSIS; SURGICAL SHOCK; and SEPTIC SHOCK. Vasoplegia that develops during or post surgery (e.g., CARDIOPULMONARY BYPASS) is called postoperative vasoplegic syndrome or vasoplegic syndrome.

Also Known As:

Post operative Vasoplegic Syndrome; Post-operative Vasoplegic Syndromes; Syndrome, Post-operative Vasoplegic; Syndromes, Post-operative Vasoplegic; Vasoplegias; Vasoplegic Syndrome, Post-operative; Vasoplegic Syndromes, Post-operative; Post-operative Vasoplegic Syndrome; Postoperative Vasoplegic Syndrome; Vasoplegic Syndrome

Networked: 128 relevant articles (4 outcomes, 6 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Hypotension (Low Blood Pressure)
2.	Burns
3.	Septic Shock (Toxic Shock Syndrome)
4.	Sepsis (Septicemia)
5.	Anaphylaxis (Anaphylactic Shock)

Experts

1.	Fischer, Gregory W: 5 articles (01/2016 - 10/2009)
2.	Rodrigues, Alfredo José: 5 articles (01/2015 - 10/2006)
3.	Evora, Paulo Roberto Barbosa: 5 articles (01/2015 - 10/2006)
4.	Vicente, Walter Vilella de Andrade: 4 articles (01/2015 - 10/2006)
5.	Evora, Paulo Roberto B: 4 articles (05/2012 - 03/2004)
6.	Gomes, Walter J: 3 articles (06/2010 - 02/2003)
7.	Hosseinian, Leila: 2 articles (01/2016 - 12/2013)
8.	Levin, Matthew A: 2 articles (01/2016 - 10/2009)
9.	Bassetto, Solange: 2 articles (01/2015 - 07/2009)
10.	Alves Junior, Lafaiete: 2 articles (01/2015 - 07/2009)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Vasoplegia:

1.	Methylene Blue (Methylthioninium Chloride)FDA Link 01/01/2015 - "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. " 12/01/2013 - "The current study identified the use of methylene blue as treatment for vasoplegia to be independently associated with poor outcomes. " 01/01/2016 - "Methylene Blue: Magic Bullet for Vasoplegia?" 10/01/2015 - "We report the use of methylene blue in a 75-year-old man who developed vasoplegic syndrome after cardiac surgery. " 10/01/2015 - "A Reminder of Methylene Blue's Effectiveness in Treating Vasoplegic Syndrome after On-Pump Cardiac Surgery."
2.	Guanylate Cyclase (Guanylyl Cyclase)IBA 05/01/2012 - "In the last 2 decades, studies have reported promising results from the administration of an NO competitor, methylene blue (MB), which is an inhibitor of the soluble guanylate cyclase (sGC), in the treatment of refractory cases of vasoplegia. " 07/01/2009 - "There is strong evidence that methylene blue (MB), an inhibitor of guanylate cyclase, is an excellent therapeutic option for vasoplegic syndrome (VS) treatment in heart surgery. " 06/01/2003 - "Guanylate cyclase inhibitors could be a novel class of agents for the treatment of norepinephrine-refractory vasoplegia after cardiopulmonary bypass. " 05/01/2012 - "Guanylate cyclase inhibition by methylene blue as an option in the treatment of vasoplegia after a severe burn. " 01/01/2008 - "Thus, some points, to a certain extent philosophical, have motivated this revision: a) To preserve and update the surgeon knowledge regarding CPB, even to keep his/her pedagogical leadership on his/her surgical team; b) To question if elderly and diabetic patients, as a result of their individual characteristics deserve more appropriate protocols similar to those adopted for children; c) One third aspect would be the questioning of the systemic inflammatory reaction caused by the blood exposure to CPB non-endothelized circuit surface, in face of the increasing importance of blood contact with the surgical wound; d) In relation to the treatment of the vasoplegic syndrome, methylene blue continues being the best therapeutical option, even so, many times are not efficient on account of a highly probable existence of a "therapeutical window" based on the guanylate cyclase dynamics of action (saturation and synthesis "de novo") and; finally, e) The reason of the title, highlighting that based on its current patterns, would the CPB be an outcome of empiricism, art, or science? "
3.	Vasopressins (Vasopressin)IBA 08/01/2014 - "Serum vasopressin concentration was not associated with vasoplegia in this population of congenital cardiac surgical patients." 05/01/2011 - "Alpha-adrenoceptor agonists and vasopressin were required to manage ongoing vasoplegia. " 07/01/2005 - "However, although the administration of vasopressin and methylenblue can not be recommended as a standard treatment it provides an additional option in individual cases of life threatening vasoplegia." 01/01/2004 - "Herein, we discuss the pathophysiology and management of vasoplegic syndrome--which is controversial--with special emphasis on the use of vasopressin in this situation." 11/01/2002 - "High-dose vasopressin is effective in the treatment of the vasoplegic syndrome after cardiac operations employing cardiopulmonary bypass."
4.	Nitric Oxide Synthase (NO Synthase)IBA 02/01/2014 - "Nitric oxide induced by a Ca(+2) independent isoform of nitric oxide synthase has been suggested to play an important role in sepsis-induced vasoplegia. " 12/01/1996 - "Endotoxin (lipopolysaccharide, LPS)-induced hypotension is, in part, mediated via induction of nitric oxide synthase (iNOS), release of nitric oxide, and suppression of vascular reactivity (vasoplegia). " 05/01/2008 - "In search of effective treatment for vasoplegia, methylene blue (MB), an inhibitor of nitric oxide synthase (NOS) and guanylate cyclase (GC), has been found to improve the refractory hypotension associated with endothelial dysfunction of VS. There is evidence that MB may indeed be effective in improving systemic hemodynamics in the setting of vasoplegia, with reportedly few side effects. " 12/01/2011 - "Methylene blue, an inhibitor of nitric oxide synthase and guanylate cyclase, may contribute to the improvement of refractory hypotension associated with endothelial dysfunction in vasoplegia. " 02/01/2015 - "The aim of this review is to discuss in detail the recent suggested alternative mechanisms of vasoplegia in severe sepsis: Overproduction of nitric oxide (NO) by activation of inducible form of nitric oxide synthase (iNOS); up-regulation of prostacyclin (PG12); vasopressin deficiency; significantly elevated levels of circulating endothelin; increased concentrations of vasodilator peptides such as adrenomedulin (AM) and calcitonin gene-related peptide (CGRP); oxidative stress inducing endothelial dysfunction and vascular hyporeactivity to vasoconstrictors; inactivation of catecholamines by oxidation; over-activation of ATP-sensitive potassium channels (KATP channels) during septic shock and their involvement in vascular dysfunction. "
5.	Norepinephrine (Noradrenaline)FDA LinkGeneric 05/01/2014 - "Vasoplegia was assessed during the immediate postoperative period, and at 24h after surgery, and was defined as a mean arterial pressure below 50mmHg, and the need for a noradrenaline perfusion of more than 0.08μg/kg/min, monitored by cardiac output and systemic vascular resistances. " 09/01/2013 - "Post-cardiac surgery vasoplegia was defined as a mean arterial blood pressure of <60 mmHg, with a cardiac index of ≥2.2 l/min/m(2) treated with continuous intravenous administration of norepinephrine. " 05/01/2005 - "In 6 patients, the vasoplegic syndrome was refractory to norepinephrine. " 06/01/2003 - "In a number of cases, however, vasoplegia is refractory to norepinephrine. " 01/01/2004 - "We report the case of a 65-year-old man who developed norepinephrine-resistant vasoplegic syndrome after elective off-pump coronary artery bypass surgery (OPCAB). "
6.	Carbon MonoxideIBA 05/01/2012 - "This article has 3 main objectives: 1) to study the guanylate cyclase inhibition by MB in burns; 2) to suggest MB as a viable, safe and useful co-adjuvant therapeutic tool of fluid resuscitation, and; 3) to suggest MB as burns hypotensive vasoplegia amine-resistant treatment.<br />"
7.	Nitric Oxide (Nitrogen Monoxide)FDA Link 09/01/2010 - "Release of nitric oxide in the systemic circulation can be a potential cause of vasoplegic syndrome. " 06/01/1996 - "A role for nitric oxide in the vasoplegic syndrome." 12/01/1996 - "Our data suggest that induction of HSP expression protects rats from LPS by blocking LPS-induced iNOS expression, leading to inhibition of the overproduction of nitric oxide and thereby reversing LPS-induced vasoplegia and LPS-induced hypotension." 10/02/2009 - "Based on these thoughts we attempted to hypothesize the causes of why this proposed discussion is not an inciting issue: (I) First hypothesis: An endothelium dysfunction classification is not important; (II) Second hypothesis: Such classification is still a "premature reductionism"; (III) Third hypothesis: Endothelium dysfunction is a multifaceted disorder and involves uncountable variations becoming impossible to propose an adequate classification; (IV) Fourth hypothesis: Vasoplegic syndrome and massive nitric oxide release accounts for the functional classification, thus, it seems that cardiovascular journals feel apprehensive about this since their point of view is closely associated with impaired endothelium nitric oxide release as a cause to increased risk of spasm and thrombosis and; (V) Fifth hypothesis: The classification is so fulfilling that it discards the need of discussion or the pioneer attitude to propose such classification has incited some degree of jealousy. " 08/01/2012 - "The accentuated nitric oxide (NO) release that is induced by the systemic inflammatory response associated with infective endocarditis (IE) and cardiopulmonary bypass (CPB) may result in catecholamine refractory hypotension (vasoplegia) and increased transfusion requirement due to platelet inhibition. "
8.	Peroxynitrous Acid (Peroxynitrite)IBA 08/01/2005 - "Large amounts of NO and peroxynitrite are responsible for hypotension, vasoplegia, cellular suffocation, apoptosis, lactic acidosis, and ultimately multiorgan failure. " 04/01/1998 - "Large amounts of NO (made by iNOS) and peroxynitrite, among other factors, are responsible for the late phase of hypotension, vasoplegia, cellular suffocation, apoptosis, lactic acidosis and multiorgan failure in endotoxic shock. " 03/01/2013 - "NO and peroxynitrite are mainly responsible for vasoplegia and vascular hyporeactivity while COX 2 enzyme is responsible for the increase in PGI2, which also contributes to hyporeactivity. " 12/01/2010 - "Nitric oxide (NO) and peroxynitrite are crucial components implicated in vasoplegia and vascular hyporeactivity. " 12/14/2011 - "Septic vasoplegia is due to reduced endogenous production of vasopressin, as well as to the overproduction of vasodilating molecules (nitric oxide, prostacyclin, peroxynitrite and kynurenine) and the opening of ATP-sensitive potassium channels. "
9.	Epinephrine (Adrenaline)FDA LinkGeneric 01/01/2013 - "Vasoplegia was managed aggressively with the intravenous infusion of high doses of epinephrine. " 01/01/2013 - "Very High Dose Epinephrine for the Treatment of Vasoplegic Syndrome during Liver Transplantation." 05/01/2015 - "Since anaphylaxis presents with significant hypovolemia and vasoplegia, aggressive fluid therapy and epinephrine are the cornerstones of management. " 07/01/2009 - "The patient became severely hypotensive with marked vasoplegia and metabolic acidosis, despite incremental doses of adrenaline and noradrenaline. " 01/14/2010 - "Paediatric septic shock is usually caused by low cardiac output, and dopamine or adrenaline are the most suitable agents for pharmacological circulation support, in contradiction to treatment in adults for whom noradrenaline is the preferred vasopressor because of dominating vasoplegia. "
10.	Vasoconstrictor AgentsIBA 01/01/2000 - "In addition, it became apparent that this overproduction of NO also plays an important role in the pathophysiology of the vascular hyporesponsiveness to vasoconstrictor agents (also termed vasoplegia) (4,5). " 01/01/2009 - "The state of vasoplegia in immediate post-cardiopulmonary bypass period is characterized by severe hypotension, supranormal cardiac output, low systemic vascular resistance (SVR), and resistance to vasoconstrictors. " 02/01/2015 - "The aim of this review is to discuss in detail the recent suggested alternative mechanisms of vasoplegia in severe sepsis: Overproduction of nitric oxide (NO) by activation of inducible form of nitric oxide synthase (iNOS); up-regulation of prostacyclin (PG12); vasopressin deficiency; significantly elevated levels of circulating endothelin; increased concentrations of vasodilator peptides such as adrenomedulin (AM) and calcitonin gene-related peptide (CGRP); oxidative stress inducing endothelial dysfunction and vascular hyporeactivity to vasoconstrictors; inactivation of catecholamines by oxidation; over-activation of ATP-sensitive potassium channels (KATP channels) during septic shock and their involvement in vascular dysfunction. "

Therapies and Procedures

1.	Cardiopulmonary Bypass (Heart-Lung Bypass) 10/01/2015 - "The inflammatory response induced by cardiopulmonary bypass decreases vascular tone, which in turn can lead to vasoplegic syndrome. " 05/01/2014 - "The incidence of vasoplegia after cardiac surgery with cardiopulmonary bypass is high during the first 24 postoperative hours. " 05/01/2014 - "Vasoplegia following cardiac surgery with cardiopulmonary bypass is associated with a high morbimortality. " 05/01/2014 - "The incidence and risk factors for vasoplegia in the early postoperative period and at 24h are investigated in patients subjected to cardiopulmonary bypass surgery. " 05/01/2014 - "The patient experienced vasoplegic syndrome while on cardiopulmonary bypass. "
2.	Resuscitation 10/15/2015 - "Vasoplegia syndrome, characterized by hypotension refractory to fluid resuscitation or high-dose vasopressors, low systemic vascular resistance, and normal-to-increased cardiac index, is associated with increased morbidity and mortality after cardiothoracic surgery. " 01/01/2013 - "As a consequence, the incidence of LV systolic dysfunction greatly depends on the time of the evaluation, reflecting the fact that, during resuscitation and treatment, vasoplegia and then LV afterload are corrected, thus unmasking septic cardiomyopathy. " 12/01/1999 - "Amiodaroneinduced asystole and vasoplegia were thought to be the causation of the failure of resuscitation. " 05/01/2012 - "This article has 3 main objectives: 1) to study the guanylate cyclase inhibition by MB in burns; 2) to suggest MB as a viable, safe and useful co-adjuvant therapeutic tool of fluid resuscitation, and; 3) to suggest MB as burns hypotensive vasoplegia amine-resistant treatment.<br />" 07/01/2015 - "Extreme vasoplegia remained refractory to maximal standard therapy including fluid resuscitation, intravenous calcium, vasopressors at very high doses, hyperinsulinemia-euglycemia therapy, lipid emulsion, and methylene blue administration. "
3.	Coronary Artery Bypass (Coronary Artery Bypass Surgery) 10/01/2008 - "Is incidence of postoperative vasoplegic syndrome different between off-pump and on-pump coronary artery bypass grafting surgery?" 01/01/2010 - "Perioperative infusion of low- dose of vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-A double-blind randomized study." 05/01/2005 - "One hundred patients scheduled for coronary artery bypass graft surgery who were at high risk for vasoplegia because they were preoperatively using angiotensin-converting enzyme inhibitors, calcium channel blockers, and heparin were randomly assigned to either receive preoperative methylene blue (group 1, n = 50) or not receive it (group 2, controls, n = 50). "
4.	Cardiac Surgical Procedures 08/01/2014 - "The purpose of this study was to investigate the incidence of vasoplegia in adult patients undergoing right-sided cardiac surgical procedures requiring cardiopulmonary bypass and to determine the vasopressin response to cardiac surgery in this population. "
5.	Transplants (Transplant) 03/01/2012 - "Patients who underwent orthotopic heart transplant (OHT) can develop vasoplegia, which is associated with high mortality and morbidity. " 03/01/2010 - "Is it possible to distinguish between vasoplegic syndrome and postreperfusion syndrome during liver graft reperfusion?" 03/01/2012 - "In the multivariate analysis, history of thyroid disease (odds ratio [OR] = 2.7, 95% CI 1.0 to 7.0, p = 0.04) and VAD prior to transplant (OR = 2.8, 95% CI 1.07 to 7.4, p = 0.03) were independent risk factors for development of vasoplegia syndrome. " 06/01/2010 - "To our knowledge, this is the first report of anaphylaxis at the time of reperfusion and may provide an explanation for cases of vasoplegic syndrome associated with graft reperfusion." 12/01/2008 - "Concomitant pulmonary hypertension and vasoplegia syndrome after heart transplant: a challenging picture."