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Last update 08 May 2025

Vasoplegia

Last update 08 May 2025

Basic Info

Synonyms

Post operative Vasoplegic Syndrome, Post-operative Vasoplegic Syndrome, Post-operative Vasoplegic Syndromes

+ [16]

Introduction

Condition of low SYSTEMIC VASCULAR RESISTANCE that develops secondary to other conditions such as ANAPHYLAXIS; SEPSIS; SURGICAL SHOCK; and SEPTIC SHOCK. Vasoplegia that develops during or post surgery (e.g., CARDIOPULMONARY BYPASS) is called postoperative vasoplegic syndrome or vasoplegic syndrome.

Drugs associated with Vasoplegia

Angiotensin II Acetate

Target

AT1R

Mechanism

AT1R agonists

Active Org.

PAION AG [+2]

Originator Org.

La Jolla Pharmaceutical Co.

Active Indication

Distributive shock [+5]

Inactive Indication

Hepatorenal Syndrome [+2]

Drug Highest PhaseApproved

First Approval Ctry. / Loc.

United States

First Approval Date21 Dec 2017

Huangqi Guizhi Wuwu Decoction

Target-

Mechanism-

Active Org.-

Originator Org.

Nanjing NingQi Medicine Science and Technology Co., Ltd.

Active Indication

Vasoplegia

Inactive Indication-

Drug Highest PhaseApproved

First Approval Ctry. / Loc.-

First Approval Date20 Jan 1800

FX-06

Target

CDH5 x Fibrinogen

Mechanism

CDH5 modulators [+1]

Active Org.

F4 Pharma GmbH

Originator Org.

FIBREX Medical, Inc.

Active Indication

Vasoplegia

Inactive Indication

Coronary Disease [+2]

Drug Highest PhasePhase 2

First Approval Ctry. / Loc.-

First Approval Date20 Jan 1800

Clinical Trials associated with Vasoplegia

NCT06952907

/ Not yet recruitingNot ApplicableIIT

Femoral Versus Radial Artery Catheterization for Invasive Arterial Pressure Monitoring in Cardiac Surgery Patients: the FERARI Randomized Superiority Study

Background: Acute circulatory failure, often presenting as arterial hypotension, is a major contributor to postoperative morbidity and mortality. Accurate blood pressure (BP) monitoring is essential for timely therapeutic intervention, particularly in patients undergoing major surgery. Among invasive BP measurement sites, the radial artery is commonly used due to its accessibility and ease of catheterization. However, physiologically, the radial artery may underestimate central arterial pressure compared to the femoral artery, especially in patients receiving vasopressors or in critical conditions. This discrepancy can lead to overtreatment with vasopressors and associated complications. Current literature on the accuracy of radial versus femoral BP monitoring is outdated and based solely on observational studies. There is a lack of high-quality randomized data to inform clinical guidelines.
Hypothesis: Femoral arterial pressure monitoring, by offering more accurate hemodynamic data, reduces the need for vasopressor support, particularly norepinephrine, compared to radial artery monitoring.
Primary Objective: To compare the effect of femoral versus radial invasive BP monitoring on the proportion of patients requiring norepinephrine at postoperative day 7 (D7) following elective cardiac surgery.
Secondary Objectives :To compare the following outcomes between the two strategies within the first 7 postoperative days: incidence of acute kidney injury (AKI) based on KDIGO criteria, incidence of cardiac complications: arrhythmias requiring treatment, myocardial injury or infarction, cardiac arrest, vaso-inotropic score (VIS), duration of vasopressor therapy, incidence of arterial catheter-related complications, 7-day postoperative mortality
Primary Endpoint: The proportion of patients receiving continuous intravenous norepinephrine from anesthesia induction to postoperative day 7.
Secondary Endpoints: AKI occurrence or need for renal replacement therapy; cardiac complications: atrial/ventricular arrhythmias, myocardial injury (troponin >99th percentile or >20% rise from baseline), myocardial infarction (biomarker elevation + ECG or echocardiographic abnormalities), cardiogenic shock, cardiac arrest; maximum VIS in the OR, ICU admission, and day 1; total norepinephrine support duration (in hours); arterial line complications: insertion failure, device dysfunction, hematoma, thrombosis, local infection, mortality at day 7
Study Design: A prospective, multicenter (Besançon and Dijon University Hospitals), randomized, superiority, single-blind, intention-to-treat clinical trial in adults undergoing elective cardiac surgery. Patients are randomized to femoral or radial artery catheterization for continuous BP monitoring.
Sample Size: Based on an expected norepinephrine use rate of 70%, a 15% absolute risk reduction, α = 0.05, and power = 90%, 162 patients per group are required. Accounting for 5% data loss, 335 patients will be enrolled.
Study Arms:
Radial group: invasive BP monitoring via radial artery catheterization Femoral group: invasive BP monitoring via femoral artery catheterization The arterial line is placed under ultrasound guidance in the operating room and maintained postoperatively in the ICU or critical care unit until no longer clinically indicated.
Eligibility Criteria Inclusion: adults aged 18-80 years undergoing elective cardiac surgery with informed consent.
Exclusion: emergency surgery, use of dual arterial lines, heart transplantation, mechanical circulatory support, contraindications to radial/femoral catheterization, legal or ethical inability to consent.
Study Timeline Inclusion period: 36 months Patient follow-up: 7 days post-surgery Total study duration: 36 months
Data Collection: Clinical data are collected by research staff using an electronic case report form (e-CRF) via CleanWeb™ software.
Expected Impact: There are currently no guidelines specifying the optimal site for invasive BP monitoring. This study aims to provide robust evidence on whether femoral BP monitoring improves clinical outcomes, reduces vasopressor use, and minimizes adverse events. Positive findings could inform future practice guidelines and lead to broader investigations in other clinical settings.

Start Date01 May 2025

Sponsor / Collaborator

Centre Hospitalier Universitaire de Besancon

ACTRN12625000193471

/ Not yet recruitingNot ApplicableIIT

Cytokine Haemadsorption to Enhance Allograft Recovery and Treatments in adult patients undergoing orthotopic heart transplantation

Start Date01 Apr 2025

Sponsor / Collaborator

St. Vincent's Hospital Sydney Pty Ltd.

NCT06615102

/ Not yet recruitingPhase 3IIT

A Prospective Angiotensin II Versus Noradrenaline Trial for Hypotension Management to Reduce Cardiac-surgery Associated Acute Kidney Injury (PAN-AKI)

The study intervention focuses on exploring the use of angiotensin II as a primary vasopressor compared to norepinephrine in cardiac surgery patients to investigate whether angiotensin II can reduce the occurrence of moderate/severe acute kidney injury (AKI). Despite its potential, as suggested by trials involving surgical patients, there is currently no human data confirming its effectiveness in preventing moderate/severe AKI in this context. The intervention aims to address this gap by evaluating angiotensin II's impact compared to norepinephrine.

Start Date01 Jan 2025

Sponsor / Collaborator

Westfälische Wilhelms-Universität Münster

[+1]

100 Clinical Results associated with Vasoplegia

100 Translational Medicine associated with Vasoplegia

0 Patents (Medical) associated with Vasoplegia

716

Literatures (Medical) associated with Vasoplegia

31 Dec 2025·Annals of Medicine

The mystery of methylene blue and its role in managing post-cardiac surgery vasoplegic shock

Article

Author: Weyand, Michael ; Heim, Christian ; Kondruweit, Markus ; Pathare, Presheet ; Elbayomi, Mohamed ; Tandler, Rene ; Dewald, Oliver

BACKGROUNDVasoplegic syndrome is associated with high mortality. Methylene blue (MB) is a guanylate cyclase inhibitor that ameliorates this re-distributive type of shock. This study aims to investigate the outcome in patients who received MB early postoperatively.METHODS2753 patients who underwent cardiac surgery utilizing cardiopulmonary bypass at our institution in a time interval of two years were identified. The incidence of vasoplegic syndrome was 7.2% (n = 200). Pharmacy records identified 84 patients (group 1, MB group) who received methylene blue and 116 patients (group 2, Control group) who didn't receive the drug. This single-center retrospective cohort study's primary outcome was in-hospital mortality. Secondary outcomes were postoperative hemodialysis, serum lactate levels at 24 h postoperatively, and intensive care unit stay length in days.RESULTSMB patients have a shorter ICU stay as compared to the control group (9 ± 8 days vs. 16 ± 6.9; p-value <.001). In the control group, postoperative hemodialysis was higher (20% in the MB group and 40% in the control group; p-value <.05). At 24 h post-op, the methylene blue group had reduced serum lactate levels (1.8 ± 1.2 vs. 4 ± 1.8 in the control group; p-value <.001). The methylene blue group had a decreased 24-hour norepinephrine dose (1.5 ± 1.2 vs. 2.8 ± 2 in the control group; p-value <.05). In-hospital mortality was not significantly different between the two groups (38% in the MB group vs. 43% in the control group).CONCLUSIONEarly postoperative administration of methylene blue in patients with vasoplegic syndrome shortens intensive care unit stay and contributes to less end-organ damage.

01 May 2025·Journal of Cardiothoracic and Vascular Anesthesia

Use of Hydroxycobolamin in the Prevention of Vasoplegic Syndrome in Adult Patients Undergoing Cardiopulmonary Bypass: A Controlled Prospective Trial

Article

Author: Ahmed, Sondos ; Ibrahim, Dalia A ; Salah, Dina

OBJECTIVEWe hypothesized that the prophylactic use of hydroxocobalamin in patients at high-risk patients to develop vasoplegia after cardiopulmonary bypass (CPB) may decrease its incidence.DESIGNThis randomized placebo-controlled prospective single-center study was conducted on high-risk patients for vasoplegia who underwent coronary artery bypass grafting (CABG).SETTINGThis study was conducted in Ain Shams University Hospitals from August 2019 to October 2023 in cardiothoracic operative rooms and its intensive care unit.PARTICIPANTSPatients included in the study were 18 to 60 years old and undergoing CABG and/or valve surgery on CPB and had 2 or more preoperative risk factors for vasoplegia. They were receiving using preoperative β-blocker or angiotensin-converting enzyme inhibitor with a preoperative ejection fraction of less than 35% and a history of thyroid disease and preoperative diuretics.INTERVENTIONSAt the end of CPB, the patients were assigned randomly into two groups: group I consisted of 30 patients who received hydroxocobalamin 5 g intravenously via the central venous catheter as a bolus over 15 minutes reconstituted in 200 mL of normal saline, and group II (control) consisted of 30 patients who received 200 mL of normal saline intravenously over 15 minutes.MEASUREMENTS AND MAIN RESULTSThe primary outcome was the change in mean arterial pressure between baseline and all time points (30 and 60 minutes after CPB initiation and 30 and 60 minutes after CPB separation) between the two groups and within the same group. The comparison regarding the change in systemic venous resistance between baseline and all time points (30 and 60 minutes before CPB initiation and 30 and 60 minutes after CPB separation) between the two groups and within the same group is calculated. Cardiac index was calculated 30 min before CPB initiation and 30 min after CPB separation. Doses of norepinephrine and its equivalent, incidence of vasoplegic shock syndrome, serum lactate, number of ventilator days, intensive care unit length of stay, hospital length of stay, incidence of norepinephrine-resistant refractory vasoplegia, acute kidney injury, shock liver and mortality in 1 week were calculated. Results showed that mean arterial pressure and systemic venous resistance at minutes 30 and 60 after CPB separation was significantly higher in group I compared to group II. Cardiac index was significantly lower in group I compared to group II. Norepinephrine requirements (µg/kg/min) at minutes 30 and 60 after CPB separation as well as average total dose norepinephrine equivalent were significantly lower in group I. Serum lactate was also found to be significantly lower in group I. Incidence of vasoplegic shock syndrome, norepinephrine-resistant refractory vasoplegia, number of ventilator days, intensive care unit length of stay, hospital length of stay, acute kidney injury, shock liver, and mortality was less frequent in group I, but the differences were statistically significant only for vasoplegia and refractory vasoplegia.CONCLUSIONThis study showed that prophylactic hydroxocobalamin can be used effectively to decrease the incidence of vasoplegic syndrome, and total vasopressor dose, as well as improve tissue perfusion in high-risk patients in cardiac surgeries.

01 Apr 2025·Journal of Cardiothoracic and Vascular Anesthesia

Vasoplegia in Heart, Lung, or Liver Transplantation: A Narrative Review

Review

Author: Convissar, David ; Pisano, Dominic V ; Dalia, Adam ; Bittner, Edward ; Berra, Lorenzo ; Ortoleva, Jamel

Vasoplegia is a pathophysiologic state of hypotension in the setting of normal or high cardiac output and low systemic vascular resistance despite euvolemia and high-dose vasoconstrictors. Vasoplegia in heart, lung, or liver transplantation is of particular interest because it is common (approximately 29%, 28%, and 11%, respectively), is associated with adverse outcomes, and because the agents used to treat vasoplegia can affect immunosuppressive and other drug metabolism. This narrative review discusses the pathophysiology, risk factors, and treatment of vasoplegia in patients undergoing heart, lung, and liver transplantation. Vasoplegia in this patient population is associated with acute kidney injury, hospital length of stay, and even survival. The mechanisms of vasoplegia in this patient population likely involve multiple pathways, including nitric oxide synthase, cyclic guanylate cyclase, cytokine release, hydrogen sulfide, adrenal axis abnormalities, and vasopressin deficiency. Contributors to vasoplegia in this population include mechanical circulatory support such as extracorporeal membrane oxygenation and cardiopulmonary bypass, organ ischemia time, preexisting infection, and medications such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and excessive sedation. Treatment of vasoplegia in this population begins with conventional catecholamines and vasopressin analogs. Occasionally, agents, including methylene blue, hydroxocobalamin, and angiotensin II, are administered. Though retrospective literature suggests a hemodynamic response to these agents in the transplant population, minimal evidence is available to guide management. In what follows, we discuss the treatment of vasoplegia in the heart, lung, and liver transplant populations based on patient characteristics and potential risk factors associated with non-catecholamine agents.

News (Medical) associated with Vasoplegia

22 Feb 2023

·www.prnewswire.com

Consensus Statement Released by Heart Failure Society of America Offers Best Practices on the Medical Management of Patients on Durable Mechanical Circulatory Support

ROCKVILLE, Md., Feb. 22, 2023 /PRNewswire/ -- An expert consensus statement published today by the Heart Failure Society of America (HFSA) offers best practices in the management of patients on durable Mechanical Circulatory Support (MCS), focusing on pharmacological therapies administered to patients on continuous flow Left Ventricular Assist Devices (LVADs). "Over the last two decades, durable MCS for the management of advanced heart failure has enjoyed a remarkable evolution, generating smaller and more hemocompatible devices with more favorable side-effect profiles, yielding progressive gains in short- and long-term survival. However, proficient medical management of patients on durable LVAD support is necessary to increase their quantity and quality of life," said Barry Trachtenberg, MD lead author and Cardiologist at Houston Methodist Heart and Vascular Center. "This consensus statement will provide clinicians with practical information they need to make decisions and support optimal patient care for the management of this unique population." As patients live longer on LVAD support, attention to the medical management of patients on durable LVAD support is paramount for advancing long-term outcomes. The consensus statement was created to provide a guide in the following areas: Guideline Directed Medical Therapies in Patients on Durable MCS Medical Therapy Directed at Complications Encountered in Patients on Durable MCS Management of Right Ventricular Failure and Pulmonary Hypertension Identifying and Managing Vasoplegia Perioperatively Management of Strokes Management of Arrhythmias Prevention and Treatment of Mucocutaneous Bleeding Management of Infectious Complications Anticoagulation and Antiplatelet Therapy Management Addressing Depression, Anxiety, and Compliance Consideration of Herbal and Nutritional Therapies The authors highlight the following key points: Postoperative long-term GDMT is recommended for ongoing neurohormonal blockade, prevention of heart failure decompensation, arrhythmia suppression, hypertension control and mitigation of renal vascular disease. Most patients with preoperative pulmonary hypertension will experience improvements in pulmonary pressures following LVAD implant, but a minority will experience cPC-PH that can lead to RV dysfunction. Aggressive preoperative optimization to reduce RV wall stress through decongestion and pulmonary vasodilator therapy, followed by careful postoperative monitoring of RV function and afterload, are critical to reduce the risk of early severe RVF. Ongoing close surveillance of LVAD outpatients, monitoring for congestion or complications that can trigger RV dysfunction (excessive LVAD speeds with septal shift, arrhythmias) are crucial for preventing heart failure exacerbation during long term LVAD therapy. Meticulous driveline care for prevention of driveline and LVAD-associated infections is crucial and prompt use of appropriate antibiotics is crucial in patients with infections Current evidence is reviewed for mitigation and treatment of GIB through pharmacologic therapy. While the HeartMate 3 pump confers a lower risk of device thrombosis and ischemic stroke, anticoagulation therapy with warfarin is still required. Patient education about nutritional and herbal therapies is important to reduce the potential for interference with anticoagulant and antiplatelet management. Regular review of programmatic clinical practice guidelines and practitioner adherence to GDMT recommendations, mean arterial pressure goals, and time in therapeutic range for anticoagulation on LVAD support should be considered to ensure optimal outcomes are achieved for more patients on LVAD support. The HFSA Expert Consensus Statement on the Medical Management of Patients on Durable Mechanical Circulatory Support is published in the Journal of Cardiac Failure and available online at . DOI: 10.1016/j.cardfail.2023.01.009 About the Heart Failure Society of America The Heart Failure Society of America, Inc. (HFSA) represents the first organized effort by heart failure experts from the Americas to provide a forum for all those interested in heart function, heart failure, and congestive heart failure (CHF) research and patient care. The mission of HFSA is to provide a platform to improve and expand heart failure care through collaboration, education, innovation, research, and advocacy. HFSA members include physicians, scientists, nurses, nurse practitioners, pharmacists, trainees, other healthcare workers and patients. For more information, visit hfsa.org. About the Journal of Cardiac Failure The Journal of Cardiac Failure publishes peer-reviewed manuscripts of interest to clinicians and researchers in the field of heart failure and related disciplines. These include original communications of scientific importance and review articles involving clinical research, health services and outcomes research, animal studies, and bench research with potential clinical applications to heart failure. The Journal also publishes manuscripts that report the design of ongoing clinical trials and editorial perspectives that comment on new developments pertinent to the field of heart failure or manuscripts published in other journals. Learn more at . Media Contact: Laura Poko 301-798-4493, ext. 226 [email protected] SOURCE Heart Failure Society of America

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