Vasoplegia Treatments: The Past, the Present, and the Future

Bruno Levy; Caroline Fritz; Elsa Tahon; Audrey Jacquot; Thomas Auchet; Antoine Kimmoun

Disclosures

Crit Care. 2018;22(52) 

In This Article

Background

Definition(s) of Vasoplegia

Known as "vasodilatory shock", this condition includes multiple and diverse etiologies (e.g., septic, cardiogenic, neurogenic, and anaphylactic shock) and ultimately results in uncontrolled vasodilation, otherwise termed "vasoplegia". The pathophysiology of vasoplegia is multifactorial and includes activation of several intrinsic vasodilatory pathways and a vascular hyporesponsiveness to vasopressors.[1] Vasoplegia occurring post-surgery is called postoperative vasoplegic syndrome or vasoplegic syndrome. In clinical practice, vasoplegia can be assessed clinically by the vasopressor dosage necessary to maintain mean arterial blood pressure (MAP) and by the drop in diastolic blood pressure reflecting vasoplegia.[2] Invariably, the necessity to use a high-dose vasopressor is highly indicative of vasoplegia, especially in the case of normal cardiac function. For further details, the reader is invited to consult the pathophysiological article published in the same series.

However, vascular responsiveness to vasopressors is probably better suited than vasoplegia for characterizing the state of vessels during shock. While the term vasoplagia refers to the static diameter of the vessel in response to specific intra-luminal and transmural pressures, vascular responsiveness to vasopressors refers to the dynamic response of the vessel to endogenous and/or exogenous vasoconstrictor agents.[1]

The present review was written based on a critical and personal appraisal of the literature. It focuses only on treatment-based pathophysiology of vasoplegia and the benefits or drawbacks of each associated therapeutic option for all types of shock, irrespective of their origin. Nevertheless, there is a clear lack of data with regard to vasoplegia treatments in non-septic shock.

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