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Definitions and pathophysiology of vasoplegic shock.

Published version
Peer-reviewed

Type

Article

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Authors

Lambden, Simon 
Creagh-Brown, Ben C  ORCID logo  https://orcid.org/0000-0002-4397-1232
Hunt, Julie 
Summers, Charlotte 
Forni, Lui G 

Abstract

Vasoplegia is the syndrome of pathological low systemic vascular resistance, the dominant clinical feature of which is reduced blood pressure in the presence of a normal or raised cardiac output. The vasoplegic syndrome is encountered in many clinical scenarios, including septic shock, post-cardiac bypass and after surgery, burns and trauma, but despite this, uniform clinical definitions are lacking, which renders translational research in this area challenging. We discuss the role of vasoplegia in these contexts and the criteria that are used to describe it are discussed. Intrinsic processes which may drive vasoplegia, such as nitric oxide, prostanoids, endothelin-1, hydrogen sulphide and reactive oxygen species production, are reviewed and potential for therapeutic intervention explored. Extrinsic drivers, including those mediated by glucocorticoid, catecholamine and vasopressin responsiveness of the blood vessels, are also discussed. The optimum balance between maintaining adequate systemic vascular resistance against the potentially deleterious effects of treatment with catecholamines is as yet unclear, but development of novel vasoactive agents may facilitate greater understanding of the role of the differing pathways in the development of vasoplegia. In turn, this may provide insights into the best way to care for patients with this common, multifactorial condition.

Description

Keywords

Shock, Vasoplegia, Anaphylaxis, Free Radicals, Humans, Hydrogen Sulfide, Prostaglandins, Shock, Septic, Vascular Resistance, Vasoplegia

Journal Title

Crit Care

Conference Name

Journal ISSN

1364-8535
1466-609X

Volume Title

22

Publisher

Springer Science and Business Media LLC