Vasodilatory Shock (VDS) may occur in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).


Occurrence: 8% of adults undergoing cardiopulmonary bypass


Criteria for vasodilatory shock:

(1) hypotension

(2) need for vasoconstrictor therapy

(3) normal or high cardiac index

(4) presence of (a) warm peripheral extremities, (b) palpable pulse (1 or 2+) and (c) capillary refill time < 2 seconds


The peak arterial lactate concentration is elevated in the patients.


Risk factors:

(1) low preoperative left ventricular ejection fraction (< 35%)

(2) pediatric patient undergoing cardiac transplant especially with use of a ventricular assist device

(3) preoperative therapy with angiotensin-converting enzyme (ACE) inhibitor


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