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Table 1 Options for the treatment of vasoplegia

From: Vasoplegic syndrome following cardiothoracic surgery—review of pathophysiology and update of treatment options

AgentMOADose
NorepinephrineSignificant α1, α2 agonism
Moderate β1 agonism
0.01–3 μg/kg/min
EpinephrineSignificant α1, α2 agonism
Significant β1 agonism
0.01–1 μg/kg/min
PhenylephrineSignificant α1, α2 agonism
No effect on β1
0.1–5 μg/kg/min
DopamineDose dependent adrenergic agonism
α1 agonism as dose increases
1–20 μg/kg/min
VasopressinRepletion of vasopressin in ADH depleted state
V1 agonism
0.01–0.1 U/min
Vitamin C
Thiamine
Hydrocortisone
Cofactor for catecholamine synthesis
Cofactor of lactate dehydrogenase (increase in lactate clearance)
Aids in vitamin C metabolism
Repletion of glucocorticoid and mineralocorticoid activity in cortisol depleted state
Inhibition of pro-inflammatory cytokines
1.5 g every 6 h
100 mg every 6 h
50 mg every 6 h
Methylene blueInhibition of guanylyl cyclase and inducible endothelial NO synthase1–2 mg/kg
HydroxocobalaminInhibition of NO directly and inducible endothelial NO synthase
Inhibition of hydrogen sulfide
5 g
Angiotensin IIAT1 agonism
Stimulation of aldosterone release
Increase in ADH synthesis
10–40 ng/kg/min