Vasodilatory shock

Vasodilatory shock, vasogenic shock, or vasoplegic shock is a

• 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

^[3]

Cause

A

The most common cause of vasodilatory shock is sepsis.^[5] Except sepsis, other causes comprise severe acute pancreatitis, post cardiopulmonary bypass vasoplegia and other triggers for a systemic inflammatory response syndrome.^{[18][19][20][21]} Low serum calcium values might take a role in vasodilatory shock.^[17]

Pathophysiology

In the cases of

Vasodilatory shock is often involved with the dysfunction of physiologic compensatory mechanisms such as the sympathetic nervous system, vasopressin arginine system and renin-angiotensin aldosterone system.^[24]

^[5][6]

Diagnosis

The definition of refractory shock or vasodilatory shock varies. In 2018, the American College of Chest Physician stated that it is presents if there is an inadequate response to high-dose vasopressor therapy defined as ≥ 0.5 mg/kg/min norepinephrine-equivalent dose.^[4]

^{[15][25][26][27]}

Management

Reversing the underlying causes of vasodilatory shock, stabilizing

The initial treatment aiming at restoring effective blood pressure in patients that have refractory shock typically starts with introducing norepinephrine and dopamine.[24] Vasopressin comes as the second-line agent.^[24]

However, high-dose therapy is linked to excessive coronary, splanchnic vasoconstriction, and hypercoagulation.

[4]^[28][29]

In those whose vasodilatory shock is caused by hypocalcemic cardiomyopathy in the context of dilated cardiomyopathy with documented both reduced heart ejection fraction and contractile performance,^[17] the uses of calcium and active vitamin D or recombinant human parathyroid hormone treatment are viable since there were many successful cases reported while given the physiological role of calcium on muscle contraction.^{[17][30][31][32]}

A successful treatment requires leveraging the respective unique contributions of a multi-disciplinary team not only