Hydroxocobalamin with or without methylene blue may improve fluid balance in critically ill patients with vasoplegic syndrome after cardiac surgery: A report of two cases

Fluid resuscitation is a cornerstone of the treatment of vasodilation associated with vasoplegic syndrome after cardiopulmonary bypass. Excessive nitric oxide production contributes to capillary leak and creates the need for ongoing volume resuscitation. In this report, the authors describe two pati...

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Bibliographic Details
Published in:Journal of cardiothoracic and vascular anesthesia 2018-02, Vol.32 (1), p.452-457
Main Authors: Zundel, Michael T., MD, Feih, Joel T., PharmD, Rinka, Joseph R.G., PharmD, Boettcher, Brent T., DO, Freed, Julie K., MD PhD, Kaiser, Markus, MD, Ghadiali, Huzefa Y., MD, Tawil, Justin N, Woehlck, Harvey J., MD, Pagel, Paul S., MD PhD
Format: Article
Language:English
Subjects:
Anesthesia & Perioperative Care
cardiac surgery
Critical Care
fluid balance
hydroxocobalamin
hypotension
methylene blue
vasoplegic syndrome
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Summary:Fluid resuscitation is a cornerstone of the treatment of vasodilation associated with vasoplegic syndrome after cardiopulmonary bypass. Excessive nitric oxide production contributes to capillary leak and creates the need for ongoing volume resuscitation. In this report, the authors describe two patients with vasoplegic syndrome after cardiac surgery in which treatment with hydroxocobalamin in the presence or absence of methylene blue reduced volume resuscitation requirements and restored catecholamine responsiveness. The current case series describes the possible efficacy of hydroxocobalamin for reversing positive fluid balance associated with catecholamine-refractory vasoplegic syndrome in cardiac surgery patients.
ISSN:1053-0770
1532-8422
DOI:10.1053/j.jvca.2017.04.002