Definitions and pathophysiology of vasoplegic shock

Lambden, Simon, Creagh-Brown, Ben C., Hunt, Julie, Summers, Charlotte and Forni, Lui G. (2018) Definitions and pathophysiology of vasoplegic shock Critical Care, 22 (174). pp. 1-8.

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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.

Item Type:	Article
Divisions :	Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :	Name Email ORCID Lambden, Simon Creagh-Brown, Ben C. Hunt, Julie j.hunt@surrey.ac.uk Summers, Charlotte Forni, Lui G. l.forni@surrey.ac.uk
Date :	6 July 2018
DOI :	10.1186/s13054-018-2102-1
Copyright Disclaimer :	© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Uncontrolled Keywords :	Vasoplegia; Shock
Depositing User :	Clive Harris
Date Deposited :	13 Jul 2018 15:53
Last Modified :	13 Jul 2018 15:53
URI:	http://epubs.surrey.ac.uk/id/eprint/848708

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