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ICU Issues with Abdominal and Pelvic Trauma
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Allison J. Tompeck, Ara J. Feinstein
Not infrequently, patients with combined abdomino-pelvic trauma have ongoing resuscitation needs without evidence of ongoing bleeding or serious organ injury. Traumatic shock (TS), also known as vasoplegic syndrome (VS), describes a state of persistent hypotension, normal or increased cardiac output, and decreased systemic vascular resistance [8, 9]. A key component of this clinical diagnosis is the absence of alternative etiologies such as sepsis, uncontrolled hemorrhage, missed injuries, abdominal compartment syndrome, or hypovolemia. Risk factors shown to increase the incidence of TS include blood transfusion, pelvic or long bone fractures, burns over a significant body surface area, traumatic injuries with an elevated injury severity score (ISS), and conditions with significant systemic inflammation such as pancreatitis. The exact pathogenesis is unclear. It is likely due to the presence of overlapping mechanistic pathways affecting vascular reactivity, which clinically culminate in persistent failure of vascular homeostasis [8, 9]. The persistent hypotension of TS uniquely results in oliguria yet normal capillary refill and oxygen arterial saturation [8].
The pharmacotherapeutic options in patients with catecholamine-resistant vasodilatory shock
Published in Expert Review of Clinical Pharmacology, 2022
Timothy E. Albertson, James A. Chenoweth, Justin C. Lewis, Janelle V. Pugashetti, Christian E. Sandrock, Brian M. Morrissey
Post-CPB vasoplegic patients have been shown to respond to MB. A series of 44 post-CPB vasoplegic patients getting bolus or infusions of MB reduced their NE requirements [134]. A 10-year propensity score matched cohort study found that MB provided additive effects on blood pressure in vasoplegic syndrome patients compared to standard vasopressor only therapy [135]. Vasoplegia associated with liver transplant has also responded to MB [126].