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Technical Advice

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Numero De Serie Antidote 8

title: post cpb vasoplegic syndrome: can novel vasopressors help? background: in recent years, vasoplegic syndrome has emerged as a major complication of cardiac surgery. treatment of refractory vasoplegia following cardiopulmonary bypass (cpb) remains a clinical challenge. despite new therapies, no consensus exists for treatment of these patients, and almost all patients with vasoplegia require treatment with vasopressors to maintain adequate tissue perfusion. the goal of treatment is to achieve an adequate blood pressure without hypotension. to achieve this goal, a multi-therapeutic approach that includes drugs and hormone replacement may be required.

Numero de serie antidote 8

hormones have a major role in the regulation of systemic blood pressure. treatment of vasoplegia involves replacement of hormone levels during the postoperative period, with the goal of returning to a normal physiological state [ 11 ].

the most common vasodilators used during the management of vasoplegia are norepinephrine and epinephrine [ 12 ]. the majority of these patients require additional dose escalation of norepinephrine [ 13 ]. other vasodilator options for patients with vasoplegia include calcium channel blockers (e.g., nimodipine), prostaglandin e1, glucagon, and somatostatin [ 14 ]. prostaglandin e1 (pge1) remains the most effective agent, but it is not available in many countries [ 15 ]. however, recent studies suggest that pge1 may not be as effective as previously reported [ 16 ]. complementary agents such as intravenous (iv) tranexamic acid and low-molecular-weight heparin (lmwh) may be used as adjunctive therapies [ 17, 18 ]. for patients with refractory vasoplegia, the use of recombinant human erythropoietin, granulocyte colony-stimulating factor, and iv albumin may be added to the armamentarium of agents used to treat this syndrome [ 19, 20 ]. iv albumin has been shown to be safe and effective for the treatment of vasoplegia [ 20, 21 ]. newer hormonal therapies such as alprostadil, dopamine, and vasopressin are being used with greater frequency in the management of vasoplegia. recent data suggest that continuous iv dopamine or dopamine plus norepinephrine may be more effective than epinephrine alone [ 22 ]. the small sample size and short follow-up period of these studies make it difficult to determine an optimal vasopressor therapy in patients with vasoplegia [ 2, 23 ]. additional randomized trials that compare multiple treatment modalities are needed to better define the role of novel vasopressor agents in the treatment of vasoplegia [ 23, 24 ].

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