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Vasodilatory Shock in the ICU: Perils, Pitfalls and Therapeutic Options

  • S. Vallabhajosyula
  • J. C. Jentzer
  • A. K. KhannaEmail author
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM)

Introduction

Circulatory failure is commonly seen in the intensive care unit (ICU) and manifests as cardiovascular instability. Shock is defined as hypotension leading to decreased organ perfusion and inadequate cellular oxygen utilization [1, 2]. Even brief periods of hypotension in the intraoperative period can lead to renal and myocardial injury [3]. The degree of hypotension leading to end organ dysfunction has been defined as a mean arterial pressure (MAP) of < 65 mmHg in the operating room [3]. The threshold MAP associated with adverse outcomes is as yet unclear in critically ill patients admitted to the ICU, and likely depends on the baseline blood pressure and other patient characteristics [4]. The most recent Surviving Sepsis Campaign Guidelines define this threshold using a MAP of < 65 mmHg [5]. Hypotension in critically ill patients is often multifactorial in etiology and is a consequence of pathological vasodilation, impaired cardiac performance, hypovolemia,...

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • S. Vallabhajosyula
    • 1
    • 2
  • J. C. Jentzer
    • 1
    • 2
  • A. K. Khanna
    • 3
    Email author
  1. 1.Department of Cardiovascular MedicineMayo ClinicRochesterUSA
  2. 2.Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterUSA
  3. 3.Center for Critical Care, Anesthesiology Institute and Department of Outcomes ResearchCleveland ClinicClevelandUSA

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