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Vasopressors and inotropes

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https://www.readbyqxmd.com/read/29210058/development-and-internal-validation-of-the-simplified-mortality-score-for-the-intensive-care-unit-sms-icu
#1
A Granholm, A Perner, M Krag, P B Hjortrup, N Haase, L B Holst, S Marker, M O Collet, A K G Jensen, M H Møller
BACKGROUND: Intensive care unit (ICU) mortality prediction scores deteriorate over time, and their complexity decreases clinical applicability and commonly causes problems with missing data. We aimed to develop and internally validate a new and simple score that predicts 90-day mortality in adults upon acute admission to the ICU: the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). METHODS: We used data from an international cohort of 2139 patients acutely admitted to the ICU and 1947 ICU patients with severe sepsis/septic shock from 2009 to 2016...
December 6, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29200066/reduced-left-ventricular-global-longitudinal-strain-predicts-prolonged-hospitalization-a-cohort-analysis-of-patients-having-aortic-valve-replacement-surgery
#2
Abraham Sonny, Andrej Alfirevic, Shiva Sale, Nicole M Zimmerman, Jing You, A Marc Gillinov, Daniel I Sessler, Andra E Duncan
BACKGROUND: Left ventricular ejection fraction (LVEF) is often preserved in patients with aortic stenosis and thus cannot distinguish between normal myocardial contractile function and subclinical dysfunction. Global longitudinal strain and strain rate (SR), which measure myocardial deformation, are robust indicators of myocardial function and can detect subtle myocardial dysfunction that is not apparent with conventional echocardiographic measures. Strain and SR may better predict postoperative outcomes than LVEF...
November 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29187011/noncardiovascular-disease-and-critical-care-delivery-in-a-contemporary-cardiac-and-medical-intensive-care-unit
#3
Michael Goldfarb, Sean van Diepen, Mark Liszkowski, Jacob C Jentzer, Isabel Pedraza, Bojan Cercek
BACKGROUND: Noncardiovascular comorbidities and critical illness are increasing in cardiovascular intensive care units (CICUs). There are limited data comparing critical care delivery, resource utilization, and costs between contemporary CICUs and medical intensive care units (MICUs). METHODS: All CICU (n = 6967; 22 748 patient-days) and MICU (n = 10 892; 39 211 patient-days) admissions to Cedars-Sinai Medical Center, a tertiary care academic medical center, between January 2011 and December 2016 were reviewed...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29171131/cpap-by-helmet-for-treatment-of-acute-respiratory-failure-after-pediatric-liver-transplantation
#4
F Chiusolo, V Fanelli, M L Ciofi Degli Atti, G Conti, F Tortora, R Pariante, L Ravà, C Grimaldi, J de Ville de Goyet, S Picardo
ARF after pediatric liver transplantation accounts for high rate of morbidity and mortality associated with this procedure. The role of CPAP in postoperative period is still unknown. The aim of the study was to describe current practice and risk factors associated with the application of helmet CPAP. In this retrospective observational cohort study, 119 recipients were divided into two groups based on indication to CPAP after extubation. Perioperative variables were studied, and determinants of CPAP application were analyzed in a multivariate logistic model...
November 24, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/29158076/microcirculation-and-red-cell-transfusion-in-patients-with-sepsis
#5
REVIEW
Øystein Wendelbo, Tor Hervig, Oddbjørn Haugen, Jerard Seghatchian, Håkon Reikvam
Early identification of sepsis followed by diagnostic blood cultures and prompt administration of appropriate intravenous antibiotics covering all likely pathogen remains the corner stone in the initial management of sepsis. Source control, obtained by harvesting microbiological cultures and removal or drainage of the infected foci, is mandatory. However, optimization of hemodynamically unstable patients including volume support supplemented with vasopressor, inotropic and transfusion of red blood cells (RBCs) in case of persistent hypoperfusion have the potential to reduce morbidity and mortality...
November 10, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/29105685/-cardiogenic-shock-from-pharmacological-treatment-to-mechanical-circulatory-support
#6
Ilaria Battistoni, Marco Marini, Alberto Lavorgna, Fabio Vagnarelli, Fabiana Lucà, Emilia Biscottini, Giorgio Caretta, Vincenza Procaccini, Letizia Riva, Gabriele Vianello, Massimo Iacoviello, Renata De Maria, Alessandro Navazio, Nadia Aspromonte, Andrea Di Lenarda, Michele Massimo Gulizia, Serafina Valente
Cardiogenic shock (CS) is a state of critical end-organ hypoperfusion due to reduced cardiac output, despite adequate filling status. The development of multiorgan dysfunction is believed to be the major contributor to the high early mortality. Little evidence exists as to which vasopressor or inotrope should best be used for early treatment; however, customized pharmacological therapy, tailored on hemodynamic monitoring, is essential to achieve normal peripheral perfusion. Moreover, an increasing number of mechanical circulatory support devices are available for hemodynamic support in patients with CS but, at present, data derived from randomized clinical trials on the effectiveness, safety, differential indications for mechanical support devices, and optimal implant timing are limited...
October 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/29062560/use-of-a-minimally-invasive-cardiac-output-monitor-to-optimise-haemodynamics-in-a-patient-with-mitral-valve-disease-undergoing-cerebrovascular-surgery
#7
Ali M Al-Mashani, Niranjan D Waje, Neeraj Salhotra, Samaresh Das, Neelam Suri, Rashid A Al-Sheheimi, Nilay Chatterjee
Patients with mitral valve disease undergoing cerebrovascular surgery face increased inherent risks due to their associated cardiac comorbidities. As such, the anaesthetic management of such patients is distinctly challenging. Simultaneous consideration of both the cerebrovascular and underlying cardiac conditions determines key anaesthetic issues, as fluids and vasopressors or inotropes need to be titrated according to haemodynamic variables in order to optimise cerebral blood flow without compromising cardiac function...
August 2017: Sultan Qaboos University Medical Journal
https://www.readbyqxmd.com/read/29054842/acute-biventricular-mechanical-circulatory-support-for-cardiogenic-shock
#8
Sudeep Kuchibhotla, Michele L Esposito, Catalina Breton, Robert Pedicini, Andrew Mullin, Ryan O'Kelly, Mark Anderson, Dennis L Morris, George Batsides, Danny Ramzy, Mark Grise, Duc Thinh Pham, Navin K Kapur
BACKGROUND: Biventricular failure is associated with high in-hospital mortality. Limited data regarding the efficacy of biventricular Impella axial flow catheters (BiPella) support for biventricular failure exist. The aim of this study was to explore the clinical utility of percutaneously delivered BiPella as a novel acute mechanical support strategy for patients with cardiogenic shock complicated by biventricular failure. METHODS AND RESULTS: We retrospectively analyzed data from 20 patients receiving BiPella for biventricular failure from 5 tertiary-care hospitals in the United States...
October 20, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29032225/right-ventricular-dysfunction-in-acute-myocardial-infarction-complicated-by-cardiogenic-shock-a-hemodynamic-analysis-of-the-should-we-emergently-revascularize-occluded-coronaries-for-cardiogenic-shock-shock-trial-and-registry
#9
Anuradha Lala, Yu Guo, Jinfeng Xu, Michele Esposito, Kevin Morine, Richard Karas, Stuart D Katz, Judith S Hochman, Daniel Burkhoff, Navin K Kapur
BACKGROUND: The prevalence and significance of right ventricular dysfunction (RVD) in patients with cardiogenic shock due to acute myocardial infarction (AMI-CS) has not been well characterized. We hypothesized that RVD is common in AMI-CS and associated with worse clinical outcomes. METHODS AND RESULTS: We retrospectively analyzed patients with available hemodynamics enrolled in the SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK (SHOCK) Trial (n=139) and Registry (n=258) to identify RVD in AMI-CS...
October 11, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/29029712/advanced-cardiopulmonary-support-for-pulmonary-embolism
#10
REVIEW
Oren Friedman, James M Horowitz, Danny Ramzy
Management of high-risk pulmonary embolism (PE) requires an understanding of the pathophysiology of PE, options for rapid clot reduction, critical care interventions, and advanced cardiopulmonary support. PE can lead to rapid respiratory and hemodynamic collapse via a complex sequence of events leading to acute right ventricular failure. Importantly, reduction in pulmonary vascular resistance must be accomplished either by systemic thrombolytics, catheter directed thrombolytics, endovascular clot extraction, or surgical embolectomy...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29027322/inotropes-and-vasopressors-in-acute-heart-failure-when-the-devil-dresses-as-an-angel
#11
EDITORIAL
Andrea Mortara
No abstract text is available yet for this article.
October 12, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/29023316/septic-shock-resuscitation-in-the-first-hour
#12
Nicholas Simpson, Francois Lamontagne, Manu Shankar-Hari
PURPOSE OF REVIEW: We reviewed the recent advances in the initial approach to resuscitation of sepsis and septic shock patients. RECENT FINDINGS: Sepsis and septic shock are life-threatening emergencies. Two key interventions in the first hour include timely antibiotic therapy and resuscitation. Before any laboratory results, the need for resuscitation is considered if a patient with suspected infection has low blood pressure (BP) or impaired peripheral circulation found at clinical examination...
December 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28994852/h%C3%A3-gdos-insulin%C3%A2-%C3%A2-euglykemiterapi-vid-sv%C3%A3-r-%C3%A2-toxisk-myokard%C3%A2-depression-ett-viktigt-tillskott-i-behandlingsarsenalen
#13
Erik Lindeman, Lovisa Baer Eriksson, Martin Thorsson, Johanna Nordmark Grass
High dose insulin euglycemia therapy - an important addition to the treatment arsenal in severe toxic myocardial depression Fifty-nine patients who developed hemodynamic symptoms necessitating treatment with vasopressors or inotropes after poisoning with calcium channel blockers (CCB) and beta blockers (BB) between January 2010 and August 2016 were identified by a search of the Poisons Information Centre database. In-hospital circulatory arrest occurred in 16/59 (27 %) and the mortality rate was 7/59 (12 %)...
October 9, 2017: Läkartidningen
https://www.readbyqxmd.com/read/28990358/long-term-safety-of-intravenous-cardiovascular-agents-in-acute-heart-failure-results-from-the-european-society-of-cardiology-heart-failure-long-term-registry
#14
Alexandre Mebazaa, Justina Motiejunaite, Etienne Gayat, Maria G Crespo-Leiro, Lars H Lund, Aldo P Maggioni, Ovidiu Chioncel, Eiichi Akiyama, Veli-Pekka Harjola, Petar Seferovic, Cecile Laroche, Marisa Sanz Julve, Eulalia Roig, Frank Ruschitzka, Gerasimos Filippatos
AIMS: The aim of this study was to assess long-term safety of intravenous cardiovascular agents-vasodilators, inotropes and/or vasopressors-in acute heart failure (AHF). METHODS AND RESULTS: The European Society of Cardiology Heart Failure Long-Term (ESC-HF-LT) registry was a prospective, observational registry conducted in 21 countries. Patients with unscheduled hospitalizations for AHF (n = 6926) were included: 1304 (18.8%) patients received a combination of intravenous (i...
October 8, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28979560/a-case-study-of-likely-wild-type-cardiac-transthyretin-amyloidosis-causing-rapid-deterioration
#15
Thomas Davies, Aarash Saleh, Gerry Coghlan, Carol Whelan, Banwari Agarwal
We present the case of an 88-year-old gentleman who presented to hospital septic with bilateral leg cellulitis, pulmonary oedema and hypotension. He had no history of heart disease but had had bilateral carpal tunnel releases. His condition deteriorated with refractory hypotension in spite of fluid filling, inotropic and vasopressor support. His echocardiogram showed an infiltrative cardiomyopathy with a speckled myocardium, severe concentric left and right ventricular increased wall thickness, diastolic dysfunction, biatrial dilatation and restrictive physiology in keeping with cardiac amyloidosis...
May 2017: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/28966921/echocardiographic-evaluation-of-hemodynamics-in-neonates-and-children
#16
REVIEW
Yogen Singh
Hemodynamic instability and inadequate cardiac performance are common in critically ill children. The clinical assessment of hemodynamic status is reliant upon physical examination supported by the clinical signs such as heart rate, blood pressure, capillary refill time, and measurement of the urine output and serum lactate. Unfortunately, all of these parameters are surrogate markers of cardiovascular well-being and they provide limited direct information regarding the adequacy of blood flow and tissue perfusion...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28948299/-cardiogenic-shock-current-evidence
#17
H Thiele
This CME article addresses the pathophysiology, incidence, current survival outcome and treatment options for patients with cardiogenic shock as a complication of acute myocardial infarction. The shock spiral of left heart failure due to cardiac infarction, subsequent vasoconstriction and paradoxical vasodilation due to the systemic inflammation response syndrome (SIRS) is a vicious circle which must be interrupted. Treatment focuses on the evidence from randomized clinical trials and the current guideline recommendations...
September 25, 2017: Herz
https://www.readbyqxmd.com/read/28915308/mutilating-purpura-fulminans-in-an-adult-with-meningococcal-sepsis
#18
María Elena Arnáiz-García, Ana María Arnáiz-García, Francisco Gutierrez-Diez, Juan Francisco Nistal, Jose María González-Santos, Ivana Pulitani, Carlos Amado-Diago, Javier Arnáiz
We report a dramatic case of meningococcal sepsis manifesting as purpura fulminans in an elderly diabetic woman. Hemodynamic instability and severe bilateral cutaneous lesions involving her hands and feet developed rapidly. Specific antibiotic therapy and the administration of inotropic and vasopressor drugs were initiated. The severity and extension of the cutaneous lesions (attributed to purpura fulminans) worsened because of the need for vasoconstrictors for the treatment of septic shock. Bilateral transmetatarsal and metacarpal amputations were required to stabilize the patient...
September 2017: Puerto Rico Health Sciences Journal
https://www.readbyqxmd.com/read/28913813/pharmacotherapy-pearls-for-emergency-neurological-life-support
#19
Gretchen M Brophy, Theresa Human
The appropriate use of medications during Emergency Neurological Life Support (ENLS) is essential to optimize patient care. Important considerations when choosing the appropriate agent include the patient's organ function and medication allergies, potential adverse drug effects, drug interactions and critical illness and aging pathophysiologic changes. Critical medications used during ENLS include hyperosmolar therapy, anticonvulsants, antithrombotics, anticoagulant reversal and hemostatic agents, anti-shivering agents, neuromuscular blockers, antihypertensive agents, sedatives, vasopressors and inotropes, and antimicrobials...
September 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28873333/role-of-echocardiography-in-reducing-shock-reversal-time-in-pediatric-septic-shock-a-randomized-controlled-trial
#20
Ahmed A El-Nawawy, Aly M Abdelmohsen, Hadir M Hassouna
OBJECTIVE: To evaluate the role of echocardiography in reducing shock reversal time in pediatric septic shock. METHODS: A prospective study conducted in the pediatric intensive care unit of a tertiary care teaching hospital from September 2013 to May 2016. Ninety septic shock patients were randomized in a 1:1 ratio for comparing the serial echocardiography-guided therapy in the study group with the standard therapy in the control group regarding clinical course, timely treatment, and outcomes...
September 3, 2017: Jornal de Pediatria
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