Vasoplegic Syndrome (Post-Cardiac Surgery Vasodilation)

Epidemiology

  • Risk Factors
    • On-Pump CABG Surgery: vasoplegic syndrome occurs more frequently after on-pump coronary artery bypas graft (CABG) surgery verses off-pump CABG surgery
    • Hypothermia During Surgery: may also increase risk of developing vasoplegic syndrome post-operatively

Pharmacology

  • Relative Vasopressin Deficiency: pre-operative arginine-vasopressin system activation probably depletes the endogenous vasopressin stores, leading to a relative vasopressin deficit post-operatively
    • High pre-operative plasma copeptin concentration: predictive of development of vasoplegic syndrome

Clinical

  • Hypotension with Low Systemic Vascular Resistance (SVR) + High Cardiac Output (CO) (see Hypotension): occurs within the first 4 hours after cardiac surgery (such as CABG)

Treatment


References

  • Is incidence of postoperative vasoplegic syndrome different between off-pump and on-pump coronary artery bypass grafting surgery? Eur J Cardiothorac Surg. 2008 Oct;34(4):820-5 [MEDLINE]
  • Post cardiac surgery vasoplegia is associated with high preoperative copeptin plasma concentration. Crit Care. 2011;15(5):R255 [MEDLINE]