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Without untreated, even brief [[hypotensive]] periods can result in [[cardiac injury|myocardial]] and [[renal injury|renal]] injury.<ref name="Vallabhajosyula Jentzer Khanna 2018 pp. 99–111">{{cite book | last=Vallabhajosyula | first=S. | last2=Jentzer | first2=J. C. | last3=Khanna | first3=A. K. | title=Annual Update in Intensive Care and Emergency Medicine 2018 | chapter=Vasodilatory Shock in the ICU: Perils, Pitfalls and Therapeutic Options | publisher=Springer International Publishing | publication-place=Cham | year=2018 | isbn=978-3-319-73669-3 | issn=2191-5709 | doi=10.1007/978-3-319-73670-9_9 | pages=99–111}}</ref> It can increased [[Case fatality rate|mortality]] in the [[critically ill]]<ref name="Vallabhajosyula Jentzer Khanna 2018 pp. 99–111"/>. Refractory hypotension has a 30-day all-cause mortality greater than 50%<ref name="Auchet Regnier Girerd Levy 2017 p. ">{{cite journal | last=Auchet | first=Thomas | last2=Regnier | first2=Marie-Alix | last3=Girerd | first3=Nicolas | last4=Levy | first4=Bruno | title=Outcome of patients with septic shock and high-dose vasopressor therapy | journal=Annals of intensive care | publisher=Springer Nature | volume=7 | issue=1 | date=2017-04-20 | issn=2110-5820 | pmid=28425079 | pmc=5397393 | doi=10.1186/s13613-017-0261-x | page=}}</ref>
Without untreated, even brief [[hypotensive]] periods can result in [[cardiac injury|myocardial]] and [[renal injury|renal]] injury.<ref name="Vallabhajosyula Jentzer Khanna 2018 pp. 99–111">{{cite book | last=Vallabhajosyula | first=S. | last2=Jentzer | first2=J. C. | last3=Khanna | first3=A. K. | title=Annual Update in Intensive Care and Emergency Medicine 2018 | chapter=Vasodilatory Shock in the ICU: Perils, Pitfalls and Therapeutic Options | publisher=Springer International Publishing | publication-place=Cham | year=2018 | isbn=978-3-319-73669-3 | issn=2191-5709 | doi=10.1007/978-3-319-73670-9_9 | pages=99–111}}</ref><ref name="Maheshwari Nathanson Munson Khangulov 2018 pp. 857–867">{{cite journal | last=Maheshwari | first=Kamal | last2=Nathanson | first2=Brian H. | last3=Munson | first3=Sibyl H. | last4=Khangulov | first4=Victor | last5=Stevens | first5=Mitali | last6=Badani | first6=Hussain | last7=Khanna | first7=Ashish K. | last8=Sessler | first8=Daniel I. | title=The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients | journal=Intensive Care Medicine | publisher=Springer Nature | volume=44 | issue=6 | year=2018 | issn=0342-4642 | doi=10.1007/s00134-018-5218-5 | pages=857–867}}</ref> It can increased [[Case fatality rate|mortality]] in the [[critically ill]]<ref name="Vallabhajosyula Jentzer Khanna 2018 pp. 99–111"/>. Refractory hypotension has a 30-day all-cause mortality greater than 50%<ref name="Auchet Regnier Girerd Levy 2017 p. ">{{cite journal | last=Auchet | first=Thomas | last2=Regnier | first2=Marie-Alix | last3=Girerd | first3=Nicolas | last4=Levy | first4=Bruno | title=Outcome of patients with septic shock and high-dose vasopressor therapy | journal=Annals of intensive care | publisher=Springer Nature | volume=7 | issue=1 | date=2017-04-20 | issn=2110-5820 | pmid=28425079 | pmc=5397393 | doi=10.1186/s13613-017-0261-x | page=}}</ref>


==Cause==
==Cause==

Revision as of 17:44, 7 February 2019

Vasodilatory shock or vasogenic shock is a medical emergency belonging to shock along with cardiogenic shock, septic shock and hypovolemic shock. In vasodilatory shock, the blood vessels suddenly relax and results in vasodilation. When the blood vessels are too relaxed leading to extreme vasodilation, blood pressure drops and blood flow becomes very low. Without enough blood pressure, blood and oxygen don’t be pushed to reach the body’s organs. If vasodilatory shock lasts more than a few minutes, the lack of oxygen starts to damage the body’s organs. Vasodilatory shock like other types of shock should be treated quickly, otherwise it can cause permanent organ damage or death as a result of multiple organ dysfunction.[1][2][3]

Treatment typically involves uses of vasopressor, inotropes, and introduction of resuscitation. [2] In case of vasodilatory shock that fails to respond to high dose of vasopressors, it's called refractory vasodilatory shock or simply refractory shock[2][4]. Adjunctive therapies include angiotensin II, hydrocortisone, thiamine, catecolamines, ascorbic acid and combinations of thereof.[2][5][6]

Signs and symptoms

  • Confusion or lack of alertness
  • Loss of consciousness
  • A sudden and ongoing rapid heartbeat
  • Sweating
  • Pale skin
  • A weak pulse
  • Rapid breathing
  • Decreased or no urine output
  • Cool hands and feet

[1]

Without untreated, even brief hypotensive periods can result in myocardial and renal injury.[7][8] It can increased mortality in the critically ill[7]. Refractory hypotension has a 30-day all-cause mortality greater than 50%[9]

Cause

A bacterial infection in the bloodstream[10], a severe allergic reaction, systemic inflammatory response syndrome[11], or damage to the nervous system (brain and nerves) may cause vasodilatory shock. [1][11][12] Besides, nearly all kinds of distributive shock such as septic shock, neurogenic shock, anaphylactic shock, drug and toxin-induced shock, endocrine shock can turn out into rafractory vasodilatory shock when the original shock becomes more severe. [13][14][15][16][17][2]

The most common cause of vasodilatory shock is sepsis[3]. Except sepsis, other causes comprise severe acute pancreatitis, post cardiopulmonary bypass vasoplegia and other triggers for a systemic inflammatory response syndrome[18][19][20][7].

Pathphysiology

In case of cardiogenic shock or acute hemorrhagic shock resulted from heart failure or from a large volume of blood loss, respectively, body deals with which by constricting peripheral vessels for the sake of reversing low arterial pressure that causes inadequate tissue perfusion.[21] Nevertheless, in vasodilatory shock, peripheral vascular smooth muscle find it difficult to constrict. [21] In refractory vasodilatory shock, peripheral vascular smooth muscle even find itself poorly respond to therapy with vasopressor drugs. [21]

[3]

Diagnosis

Management

[2][22][23]

Epidemiology

Prognosis

Reference

  1. ^ a b c "National Heart, Lung, and Blood Institute (NHLBI)". Cardiogenic Shock. Retrieved 2019-02-07.
  2. ^ a b c d e f Jentzer, Jacob C.; Vallabhajosyula, Saraschandra; Khanna, Ashish K.; Chawla, Lakhmir S.; Busse, Laurence W.; Kashani, Kianoush B. (2018). "Management of Refractory Vasodilatory Shock". Chest. 154 (2). Elsevier BV: 416–426. doi:10.1016/j.chest.2017.12.021. ISSN 0012-3692. PMID 29329694.
  3. ^ a b c Gkisioti, S; Mentzelopoulos, SD (2011). "Vasogenic shock physiology". Open access emergency medicine : OAEM. 3: 1–6. doi:10.2147/OAEM.S10388. ISSN 1179-1500. PMC 4753960. PMID 27147845.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  4. ^ Masarwa, Reem; Paret, Gideon; Perlman, Amichai; Reif, Shimon; Raccah, Bruria Hirsh; Matok, Ilan (2017-01-05). "Role of vasopressin and terlipressin in refractory shock compared to conventional therapy in the neonatal and pediatric population: a systematic review, meta-analysis, and trial sequential analysis". Critical care (London, England). 21 (1). Springer Nature. doi:10.1186/s13054-016-1589-6. ISSN 1364-8535. PMC 5217634. PMID 28057037.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  5. ^ Khanna, Ashish; English, Shane W.; Wang, Xueyuan S.; Ham, Kealy; Tumlin, James; Szerlip, Harold; Busse, Laurence W.; Altaweel, Laith; Albertson, Timothy E.; Mackey, Caleb; McCurdy, Michael T.; Boldt, David W.; Chock, Stefan; Young, Paul J.; Krell, Kenneth; Wunderink, Richard G.; Ostermann, Marlies; Murugan, Raghavan; Gong, Michelle N.; Panwar, Rakshit; Hästbacka, Johanna; Favory, Raphael; Venkatesh, Balasubramanian; Thompson, B. Taylor; Bellomo, Rinaldo; Jensen, Jeffrey; Kroll, Stew; Chawla, Lakhmir S.; Tidmarsh, George F.; Deane, Adam M. (2017-08-03). "Angiotensin II for the Treatment of Vasodilatory Shock". The New England journal of medicine. 377 (5). New England Journal of Medicine (NEJM/MMS): 419–430. doi:10.1056/nejmoa1704154. ISSN 0028-4793. PMID 28528561.
  6. ^ Dünser, M.; Wenzel, V.; Mayr, A. J.; Hasibeder, W. R. (2002-08-01). "Arginin-Vasopressin im vasodilatatorischen Schock". Der Anaesthesist (in German). 51 (8). Springer Nature: 650–659. doi:10.1007/s00101-002-0349-y. ISSN 0003-2417. PMID 12391525.
  7. ^ a b c Vallabhajosyula, S.; Jentzer, J. C.; Khanna, A. K. (2018). "Vasodilatory Shock in the ICU: Perils, Pitfalls and Therapeutic Options". Annual Update in Intensive Care and Emergency Medicine 2018. Cham: Springer International Publishing. pp. 99–111. doi:10.1007/978-3-319-73670-9_9. ISBN 978-3-319-73669-3. ISSN 2191-5709.
  8. ^ Maheshwari, Kamal; Nathanson, Brian H.; Munson, Sibyl H.; Khangulov, Victor; Stevens, Mitali; Badani, Hussain; Khanna, Ashish K.; Sessler, Daniel I. (2018). "The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients". Intensive Care Medicine. 44 (6). Springer Nature: 857–867. doi:10.1007/s00134-018-5218-5. ISSN 0342-4642.
  9. ^ Auchet, Thomas; Regnier, Marie-Alix; Girerd, Nicolas; Levy, Bruno (2017-04-20). "Outcome of patients with septic shock and high-dose vasopressor therapy". Annals of intensive care. 7 (1). Springer Nature. doi:10.1186/s13613-017-0261-x. ISSN 2110-5820. PMC 5397393. PMID 28425079.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  10. ^ Singer, Mervyn; Deutschman, Clifford S.; Seymour, Christopher Warren; Shankar-Hari, Manu; Annane, Djillali; Bauer, Michael; Bellomo, Rinaldo; Bernard, Gordon R.; Chiche, Jean-Daniel; Coopersmith, Craig M.; Hotchkiss, Richard S.; Levy, Mitchell M.; Marshall, John C.; Martin, Greg S.; Opal, Steven M.; Rubenfeld, Gordon D.; van der Poll, Tom; Vincent, Jean-Louis; Angus, Derek C. (2016-02-23). "The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)". JAMA. 315 (8). American Medical Association (AMA): 801. doi:10.1001/jama.2016.0287. ISSN 0098-7484. PMC 4968574794087. PMID 26903338. {{cite journal}}: Check |pmc= value (help)
  11. ^ a b Williams, Felicia N; Herndon, David N; Hawkins, Hal K; Lee, Jong O; Cox, Robert A; Kulp, Gabriela A; Finnerty, Celeste C; Chinkes, David L; Jeschke, Marc G (2009). "The leading causes of death after burn injury in a single pediatric burn center". Critical care (London, England). 13 (6). Springer Nature: R183. doi:10.1186/cc8170. ISSN 1364-8535. PMC 2811947. PMID 19919684.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  12. ^ Banks, Peter A; Bollen, Thomas L; Dervenis, Christos; Gooszen, Hein G; Johnson, Colin D; Sarr, Michael G; Tsiotos, Gregory G; Vege, Santhi Swaroop (2012-10-25). "Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus". Gut. 62 (1). BMJ: 102–111. doi:10.1136/gutjnl-2012-302779. ISSN 0017-5749. PMID 23100216. {{cite journal}}: Check date values in: |year= / |date= mismatch (help)
  13. ^ "Definition, classification, etiology, and pathophysiology of shock in adults". UpToDate. Retrieved 2019-02-07.
  14. ^ Vincent, Jean-Louis; De Backer, Daniel (2013-10-31). Finfer, Simon R.; Vincent, Jean-Louis (eds.). "Circulatory Shock". The New England journal of medicine. 369 (18). New England Journal of Medicine (NEJM/MMS): 1726–1734. doi:10.1056/nejmra1208943. ISSN 0028-4793. PMID 24171518.
  15. ^ De Backer, Daniel; Biston, Patrick; Devriendt, Jacques; Madl, Christian; Chochrad, Didier; Aldecoa, Cesar; Brasseur, Alexandre; Defrance, Pierre; Gottignies, Philippe; Vincent, Jean-Louis (2010-03-04). "Comparison of Dopamine and Norepinephrine in the Treatment of Shock". The New England journal of medicine. 362 (9). New England Journal of Medicine (NEJM/MMS): 779–789. doi:10.1056/nejmoa0907118. ISSN 0028-4793. PMID 20200382.
  16. ^ Kheng, Cheah P; Rahman, Nik H (2012-07-24). "The use of end-tidal carbon dioxide monitoring in patients with hypotension in the emergency department". International journal of emergency medicine. 5 (1). Springer Nature. doi:10.1186/1865-1380-5-31. ISSN 1865-1380. PMC 3585511. PMID 22828152.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  17. ^ Minisola, Salvatore; Cipriani, Cristiana; Colangelo, Luciano; Biamonte, Federica; Pepe, Jessica (2019). "Serum Calcium Values and Refractory Vasodilatory Shock". Chest. 155 (1). Elsevier BV: 242. doi:10.1016/j.chest.2018.08.1066. ISSN 0012-3692.
  18. ^ Sablotzki, Armin; Friedrich, Ivar; Mühling, Jörg; Dehne, Marius G; Spillner, Jan; Silber, Rolf E; Czeslik, Elke (2002). "The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multiorgan dysfunctions". Perfusion. 17 (2). SAGE Publications: 103–109. doi:10.1177/026765910201700206. ISSN 0267-6591. PMID 11958300.
  19. ^ Hirai, S (2003). "Systemic inflammatory response syndrome after cardiac surgery under cardiopulmonary bypass". Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 9 (6): 365–70. ISSN 1341-1098. PMID 15003097.
  20. ^ Herget-Rosenthal, S.; Saner, F.; Chawla, L. S. (2008-02-20). "Approach to Hemodynamic Shock and Vasopressors". Clinical Journal of the American Society of Nephrology. 3 (2). American Society of Nephrology (ASN): 546–553. doi:10.2215/cjn.01820407. ISSN 1555-9041.
  21. ^ a b c Landry, Donald W.; Oliver, Juan A. (2001-08-23). Epstein, Franklin H. (ed.). "The Pathogenesis of Vasodilatory Shock". New England Journal of Medicine. 345 (8). New England Journal of Medicine (NEJM/MMS): 588–595. doi:10.1056/nejmra002709. ISSN 0028-4793.
  22. ^ Wakefield, Brett J.; Sacha, Gretchen L.; Khanna, Ashish K. (2018). "Vasodilatory shock in the ICU and the role of angiotensin II". Current opinion in critical care. 24 (4). Ovid Technologies (Wolters Kluwer Health): 277–285. doi:10.1097/mcc.0000000000000517. ISSN 1070-5295. PMID 29877879.
  23. ^ Levy, Bruno; Fritz, Caroline; Tahon, Elsa; Jacquot, Audrey; Auchet, Thomas; Kimmoun, Antoine (2018-02-27). "Vasoplegia treatments: the past, the present, and the future". Critical Care. 22 (1). Springer Nature. doi:10.1186/s13054-018-1967-3. ISSN 1364-8535.{{cite journal}}: CS1 maint: unflagged free DOI (link)
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