Vasoplegic Syndrome in Patients Undergoing Cardiac Surgery: A Literature Review

2021 ◽  
Vol 32 (2) ◽  
pp. 137-145
Author(s):  
Colleen M. Nash
Keyword(s):  
Methylene Blue ◽  
Cardiac Surgery ◽  
Vascular Tone ◽  
Surgical Trauma ◽  
First Line ◽  
Vascular Dysregulation ◽  
Increased Risk ◽  
Research And Education ◽  
Complex Surgical Procedures ◽  
Vasoplegic Syndrome

Vasoplegic syndrome is a rising problem affecting morbidity and mortality in patients undergoing cardiac surgery. Vasoplegia is a vasodilatory, shocklike syndrome characterized by decreased systemic vascular resistance, normal to high cardiac index, and hypotension refractory to fluid resuscitation and vasopressors. This review describes the presentation, physiology, risk factors, treatments, and implications of vasoplegia after cardiac surgery. No standardized methods for diagnosing and treating vasoplegia are available. Vasoplegia is caused by surgical trauma, systemic inflammation, and vascular dysregulation. Patients with comorbidities and those undergoing complex surgical procedures are at increased risk for vasoplegia. The use of β-blockers is protective. Vasoplegia is potentially reversible. Vasopressin is likely the most effective first-line vasopressor, and the use of methylene blue and/or hydroxocobalamin may restore vascular tone. Alternative therapies such as methylene blue and hydroxocobalamin show promise, but additional research and education are needed.

scholarly journals A Reminder of Methylene Blue's Effectiveness in Treating Vasoplegic Syndrome after On-Pump Cardiac Surgery

2015 ◽  
Vol 42 (5) ◽  
pp. 491-494 ◽  
Author(s):  
Joshua Manghelli ◽  
Lisa Brown ◽  
Hany B. Tadros ◽  
Nabil A. Munfakh
Keyword(s):  
Nitric Oxide ◽  
Methylene Blue ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Inflammatory Response ◽  
Vascular Tone ◽  
Standard Treatment ◽  
Intravenous Fluid ◽  
Vasoplegic Syndrome

The inflammatory response induced by cardiopulmonary bypass decreases vascular tone, which in turn can lead to vasoplegic syndrome. Indeed the hypotension consequent to on-pump cardiac surgery often necessitates vasopressor and intravenous fluid support. Methylene blue counteracts vasoplegic syndrome by inhibiting the formation of nitric oxide. We report the use of methylene blue in a 75-year-old man who developed vasoplegic syndrome after cardiac surgery. After the administration of methylene blue, his hypotension improved to the extent that he could be weaned from vasopressors. The use of methylene blue should be considered in patients who develop hypotension refractory to standard treatment after cardiac surgery.

Methylene blue: potential use of an antique molecule in vasoplegic syndrome during cardiac surgery

2011 ◽  
Vol 9 (12) ◽  
pp. 1519-1525 ◽  
Author(s):  
Sébastien Lenglet ◽  
François Mach ◽  
Fabrizio Montecucco
Keyword(s):  
Methylene Blue ◽  
Cardiac Surgery ◽  
Potential Use ◽  
Vasoplegic Syndrome

Preoperative Methylene Blue Administration in Patients at High Risk for Vasoplegic Syndrome During Cardiac Surgery

2005 ◽  
Vol 79 (5) ◽  
pp. 1615-1619 ◽  
Author(s):  
Ertuğrul Özal ◽  
Erkan Kuralay ◽  
Vedat Yildirim ◽  
Selim Kilic ◽  
Cengiz Bolcal ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Cardiac Surgery ◽  
High Risk ◽  
Vasoplegic Syndrome

scholarly journals Use of methylene blue in vasoplegic syndrome that developed during non-cardiac surgery - A case report -

2019 ◽  
Vol 14 (4) ◽  
pp. 460-464
Author(s):  
In Duk Oh ◽  
Eunsil Shin ◽  
Jong-Mi Jeon ◽  
Hyunho Woo ◽  
Jeong-Hyun Choi
Keyword(s):  
Methylene Blue ◽  
Cardiac Surgery ◽  
Case Report ◽  
Vasoplegic Syndrome

scholarly journals Methylene Blue for Vasoplegic Syndrome

2017 ◽  
Vol 20 (5) ◽  
pp. 234 ◽  
Author(s):  
Alexander T. Booth ◽  
Patrick D. Melmer ◽  
Benjamin Tribble ◽  
J. Hunter Mehaffey ◽  
Curt Tribble
Keyword(s):  
Methylene Blue ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Side Effects ◽  
Vasodilatory Shock ◽  
Prospective Data ◽  
Dosing Strategies ◽  
High Doses ◽  
Vasoactive Medications ◽  
Vasoplegic Syndrome

Vasoplegic syndrome is a form of vasodilatory shock that occurs frequently in patients who undergo cardiac surgery requiring cardiopulmonary bypass (CBP). Treatment often demands high doses of vasopressors over sustained periods for hypotension that can be refractory to standard vasoactive medications. Furthermore, the development of vasoplegia greatly contributes to morbidity and mortality following cardiac surgery. Methylene blue (MB) has become a popular therapy for cardiac vasoplegia despite a paucity of prospective data to direct its use. Therefore, the aim of this study was to review available data regarding mechanisms, dosing strategies, and side effects of MB, with a focus on its applications for vasoplegia in cardiac surgery.

scholarly journals The additional use of methylene blue has a decatecholaminisation effect on cardiac vasoplegic syndrome after cardiac surgery

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Walter Petermichl ◽  
Michael Gruber ◽  
Ina Schoeller ◽  
Kwahle Allouch ◽  
Bernhard M. Graf ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Cardiac Surgery ◽  
Standard Treatment ◽  
Ventricular Dysfunction ◽  
Systemic Disease ◽  
High Dose ◽  
High Doses ◽  
Severe Systemic Disease ◽  
Vasoplegic Syndrome ◽  
Adult Cardiac Surgery

Abstract Background Postoperative vasoplegia with minimal responsiveness to vasopressors is common after cardiac surgery. Called cardiac vasoplegic syndrome (CVS), it is caused by multiple factors. Treating CVS involves a high dose of fluids and catecholamines, however high doses of catecholamines and fluids are associated with serious side effects. There is evidence that new therapeutic strategies can lead to a reduction in norepinephrine doses and mortality in CVS. Specifically, the use of non-adrenergic vasopressors such as methylene blue (MB) can be beneficial. Methods We retrospectively analyzed the electronic records of 8716 adult cardiac surgery patients from November 2008 to December 2016. Medication, hemodynamic and outcome parameter data were analyzed for CVS until discharge. We determined CVS according to the following parameters: a postoperative onset of ≤24 h, a reduced mean arterial pressure (MAP) of < 70 mmHg, a dose of norepinephrine ≥0.8 mg*h− 1 and a continuously increasing need for catecholamine, without ventricular dysfunction. Results We identified 513 patients with CVS. Perioperative risk factors were higher in patients treated with methylene blue (MB). Before MB administration patients had a significantly higher dose of norepinephrine, and MAP increased after MB administration. Norepinephrine could be reduced after MB administration and MAP remained stable at the same level even after the reduction of norepinephrine. Conclusions CVS patients have a severe systemic disease accompanied by significant operative stress and a high catecholamine requirement. The administration of MB in addition to standard treatment for CVS in the first 24 h was accompanied by an increase in MAP followed by a decrease in vasopressor requirement, indicating that early MB administration can be beneficial.

scholarly journals The use of intravenous hydroxocobalamin as a rescue in methylene blue-resistant vasoplegic syndrome in cardiac surgery

2017 ◽  
Vol 20 (4) ◽  
pp. 462 ◽  
Author(s):  
ArcherKilbourne Martin ◽  
Yi Cai ◽  
Anwar Mack ◽  
BethL Ladlie
Keyword(s):  
Methylene Blue ◽  
Cardiac Surgery ◽  
Vasoplegic Syndrome

scholarly journals Copeptin assessment to predict vasoplegia after cardiopulmonary by-pass. An observational cohort study.

2020 ◽  
Author(s):  
Daniela Pasero ◽  
Alessandro Maria Berton ◽  
Giovanna Motta ◽  
Riccardo Raffaldi ◽  
Giancarlo Fornaro ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Life Support ◽  
Standard Dose ◽  
Preoperative Evaluation ◽  
Multivariable Analysis ◽  
Control Group ◽  
Off Pump ◽  
Increased Risk ◽  
Vasopressin Secretion ◽  
Vasoplegic Syndrome

Abstract Background Post-cardiotomy vasoplegic syndrome is a vasodilatory shock characterized by a decrease of vascular tone with a normal or increased cardiac output. A relative deficit in vasopressin secretion in the postoperative was hypothesized. Copeptin is secreted in equimolar ratio with vasopressin but it is more stable and easier to measure. The aim of the present study was to investigate whether perioperative copeptin was associated with post-cardiotomy vasoplegic syndrome. Methods All patients scheduled for cardiac surgery were evaluated. Exclusion criteria were age < 18 years old, corticosteroids therapy, heart transplantation, extra-circulatory life support, sepsis, preoperative use of vasoactive drugs, off-pump surgery, chronic hepatic and renal failure, paraneoplastic syndrome, lack of informed consent. Post-cardiotomy vasoplegic syndrome was defined as a mean arterial pressure < 60 mmHg, a reduction of systemic vascular resistances < 1200 dyn*s/cm 5 *m 2 and/or the need of nor-epinephrine ³ 0.1 µg/kg/min. All patients underwent a preoperative evaluation of the corticotropin stimulation test; then, before surgery (T0), on day one after surgery (T1) and after 7 days (T2) copeptin and NT-proBNP concentration were measured. Results Among 55 enrolled patients, 9 (16.3%) developed post-cardiac surgery vasoplegia. Patients with vasoplegia had higher preoperative level of copeptin (19.2 pmol/L, IQR 17.89 – 21.29 vs 11.39 pmol/L, IQR 6.33 - 14.78; p < 0.001) and NT-proBNP (1435 pg/ml, IQR 721.75 – 1836.25 vs 365.5 pg/ml, IQR 141 - 977); p = 0.006) compared to the control group. At the multivariable analysis, preoperative copeptin resulted a significant predictor of vasoplegia (OR 1.56, 95% CI 1.002-1.33) and the ROC analysis showed an accurate copeptin cut off able to identify vasoplegic patients (> 16.9 pmol/L, AUC = 0.86, 95% CI 0.73-0.94). Otherwise, a lack of response to the low dose corticotropin test was not a predictor of PCVS; no patient presented a pathological response to the standard dose test. ConclusionsIncreased preoperative copeptin and NT-proBNP levels might be associated with an increased risk to develop post-cardiotomy vasoplegic syndrome. Our results suggest that patients with a decompensated neuroendocrine control of cardiovascular function are more prone to develop postoperative vasoplegia.

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