Definitions and pathophysiology of vasoplegic shock

Area of Science:

• Cardiovascular Physiology
• Critical Care Medicine

Background:

• Vasoplegia is a syndrome of pathological low systemic vascular resistance, presenting as reduced blood pressure with normal or elevated cardiac output.
• This syndrome is observed in diverse clinical settings like septic shock, post-cardiac bypass, surgery, burns, and trauma.
• Lack of uniform clinical definitions hinders translational research in vasoplegia.

Purpose of the Study:

• To review the role and diagnostic criteria of vasoplegia in various clinical contexts.
• To explore intrinsic and extrinsic factors contributing to vasoplegia.
• To discuss potential therapeutic interventions for vasoplegia.

Main Methods:

• Review of intrinsic pathways (nitric oxide, prostanoids, endothelin-1, hydrogen sulfide, reactive oxygen species).
• Discussion of extrinsic drivers (glucocorticoid, catecholamine, vasopressin responsiveness).
• Analysis of the balance between systemic vascular resistance and catecholamine therapy.

Main Results:

• Identified key intrinsic and extrinsic pathways involved in vasoplegia.
• Highlighted the challenges posed by non-uniform definitions for research.
• Emphasized the unclear optimal balance in managing systemic vascular resistance.

Conclusions:

• Vasoplegia is a multifactorial condition requiring further research into its underlying mechanisms.
• Development of novel vasoactive agents may improve understanding and treatment.
• Insights into vasoplegia pathways can enhance patient care in critical settings.