Vasoplegic syndrome after cardiovascular surgery: A review of pathophysiology and outcome‐oriented therapeutic management

Vasoplegic Syndrome After Cardiovascular Surgery: A Review of Pathophysiology and Outcome Oriented Therapeutic Management

10.22541/au.162289880.08743773/v1 ◽

2021 ◽

Author(s):

Vishnu Datt ◽

Rachna Wadhwa ◽

Varun Sharma ◽

Sanjula Virmani ◽

Harpreet Minhas ◽

...

Keyword(s):

Nitric Oxide ◽

Cardiac Surgery ◽

Treatment Options ◽

Cyclic Guanosine Monophosphate ◽

Guanosine Monophosphate ◽

Therapeutic Interventions ◽

Therapeutic Management ◽

Ethical Approval ◽

Oxide Synthase ◽

Vasoplegic Syndrome

Vasoplegic syndrome (VPS) is defined as systemic hypotension due to profound vasodilatation and loss of systemic vascular resistance (SVR), despite normal or increased cardiac index (CI). It occurs in 9- 44% of cardiac surgery patients after cardiopulmonary bypass (CPB) and is associated with significant morbidity and mortality. The pathogenesis of VPS is multifactorial involving the activation of contact, coagulation, and complement systems and the activation of leukocytes. platelets and endothelial cells resulting in an imbalance in the regulation of the vascular tone; inducible nitric oxide synthase [iNOS] triggered by inflammatory cytokines during CPB produces nitric oxide (NO), which increases vascular levels of cyclic guanosine monophosphate (cGMP), resulting in vasodilation. leading to postcardiac surgery VPS. Standard treatment options for severe refractory VPS are extremely limited and include vasopressor support. latest Surviving Sepsis Campaign guidelines also consider that the best therapeutic management of vascular hypo- responsiveness to vasopressors could be a combination of multiple vasopressors, including norepinephrine (NE) and early prescription of vasopressin. This review will address the various definitions, risk factors, pathophysiology, potential cardiac candidates, and potential therapeutic interventions for VPS following cardiac surgery focussed on the outcome. This review did not require any ethical approval or consent from the patients.

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The Collaborative Medical and Behavioral Management of Chronic Cough

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd19.2.49 ◽

2009 ◽

Vol 19 (2) ◽

pp. 49-57

Author(s):

Brian E. Petty ◽

Seth H. Dailey

Keyword(s):

Medical Care ◽

Chronic Cough ◽

Therapeutic Management ◽

Ambulatory Setting ◽

Behavioral Management ◽

Speech Language Pathologists ◽

Speech Language Pathologist ◽

The Many ◽

Frequent Reason

Abstract Chronic cough is the most frequent reason cited by patients for seeking medical care in an ambulatory setting and may account for 10% to 38% of a pulmonologist's practice. Because chronic cough can be caused by or correlated with a wide array of disorders and behaviors, the diagnosis of etiologic factors and determination of appropriate therapeutic management in these cases can prove to be daunting for the physician and speech-language pathologist alike. This article will describe the phenomenon of chronic cough, discuss the many etiologic factors to consider, and review some of the more common ways in which speech-language pathologists and physicians collaborate to treat this challenging condition.

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