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Vasopressors and inotropes

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https://www.readbyqxmd.com/read/29441350/perioperative-goal-directed-therapy-using-invasive-uncalibrated-pulse-contour-analysis
#1
Bernd Saugel, Daniel A Reuter
"Perioperative goal-directed therapy" (PGDT) aims at an optimization of basic and advanced global hemodynamic variables to maintain adequate oxygen delivery to the end-organs. PGDT protocols help to titrate fluids, vasopressors, or inotropes to hemodynamic target values. There is considerable evidence that PGDT can improve patient outcome in high-risk patients if both fluids and inotropes are administered to target hemodynamic variables reflecting blood flow. Despite this evidence, PGDT strategies aiming at an optimization of blood flow seem to be not well implemented in routine clinical care...
2018: Frontiers in Medicine
https://www.readbyqxmd.com/read/29438568/haemodynamic-assessment-and-support-in-sepsis-and-septic-shock-in-resource-limited-settings
#2
David Misango, Rajyabardhan Pattnaik, Tim Baker, Martin W Dünser, Arjen M Dondorp, Marcus J Schultz
Background: Recommendations for haemodynamic assessment and support in sepsis and septic shock in resource-limited settings are largely lacking. Methods: A task force of six international experts in critical care medicine, all of them members of the Global Intensive Care Working Group of the European Society of Intensive Care Medicine and with extensive bedside experience in resource-limited intensive care units, reviewed the literature and provided recommendations regarding haemodynamic assessment and support, keeping aspects of efficacy and effectiveness, availability and feasibility and affordability and safety in mind...
February 9, 2018: Transactions of the Royal Society of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/29404312/advances-in-diagnosis-and-management-of-hemodynamic-instability-in-neonatal-shock
#3
REVIEW
Yogen Singh, Anup C Katheria, Farha Vora
Shock in newborn infants has unique etiopathologic origins that require careful assessment to direct specific interventions. Early diagnosis is key to successful management. Unlike adults and pediatric patients, shock in newborn infants is often recognized in the uncompensated phase by the presence of hypotension, which may be too late. The routine methods of evaluation used in the adult and pediatric population are often invasive and less feasible. We aim to discuss the pathophysiology in shock in newborn infants, including the transitional changes at birth and unique features that contribute to the challenges in early identification...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29398754/the-effect-of-prophylactic-infusion-of-combined-ephedrin-and-phenylephrine-on-maternal-hemodynamic-after-spinal-anesthesia-for-cesarean-section-a-randomized-clinical-trial
#4
Simin Atashkhoie, Hojat Pourfathi, Bahman Naghipour, Shahla Meshgi
Several techniques have been proposed to prevent hypotension in obstetric patients. Ephedrine and phenylephrine are individually used to prevent maternal hypotension; however, each has its own drawbacks. Some researchers have reported that the infusion of combined ephedrine and phenylephrine immediately after spinal anesthesia for cesarean delivery reduces the incidence of maternal hypotension. Other studies have indicated that the combination is not superior to the infusion of an individual agent. The present study aimed to evaluate the effect of prophylactic infusion of ephedrine and phenylephrine before the induction of spinal anesthesia for cesarean section on maternal hemodynamic...
January 2018: Iranian Journal of Medical Sciences
https://www.readbyqxmd.com/read/29378423/receipt-of-vasopressors-is-positively-associated-with-the-length-of-the-actively-dying-process-in-hospitalization
#5
Hsiao-Chen Chou, Hsien-Liang Huang, Chiang-Yi Chen, Chuan-Lan Wang, Chin-Chung Shu, Nin-Chieh Hsu, Yu-Feng Lin, Jin-Shing Chen, Wang-Huei Sheng
BACKGROUND: End-of-life care is important in general hospitalization care. However, the clinical impact of using vasopressors on the length of the actively dying process is still controversial. METHODS: We reviewed patients who were hospitalized in general wards and died before discharge. We classified the patients into 2 groups: those who received vasopressors (RVs) and those who did not receive vasopressors (NRV). We analyzed the factors associated with the length of hospital stay (LOS) and the length of the actively dying process...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29368903/-anesthesic-management-during-total-organic-separation-of-pygopagus-conjoined-twins
#6
Mayra Lizeth Nava-Martínez, Enriqueta Macias-Miranda, Karla Guadalupe Lozada-Rosete, Juan José Dosta-Herrera
BACKGROUND: Conjoined twins are among the most rare and challenging congenital malformations. The incidence varies from 1:30 000 to 1:200 000 live births. Pygopagus twins account for about 10 to 18% of all conjoined twins. CLINICAL CASE: We report the case of male conjoined pygopagus twins. They shared medullary canal, anal canal and sacrococcygeal region, without any degree of cross circulation. At the moment of the surgery, twin 1 had congenital heart disease without medical treatment...
January 2018: Revista Médica del Instituto Mexicano del Seguro Social
https://www.readbyqxmd.com/read/29338605/noteworthy-articles-in-2017-for-cardiothoracic-critical-care
#7
Natalia S Ivascu, Liang Shen, Edward Noguera, Brigid C Flynn
In 2017, many high-impact articles appeared in the literature. This is the third edition of an annual review of articles related to postoperative cardiac critical care that may affect the cardiac anesthesiologist. This year explores vasopressor and inotropic support, timing of renal replacement therapy, management of postoperative respiratory insufficiency, and targeted temperature therapy.
January 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29336676/vasopressors-in-sepsis
#8
Kristin P Colling, Kaysie L Banton, Greg J Beilman
BACKGROUND: Sepsis accounts for 10% of intensive care unit admissions and significant healthcare costs. Although the mortality rate from sepsis has been decreasing with better critical care, early identification of septic patients, and prompt interventions, the mortality rate remains 20%-30%. METHOD: Review of the English-language literature. RESULTS: Norepinephrine is the first-line vasopressor in shock and is associated with a lower mortality rate as well as fewer adverse effects...
January 16, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29319574/risk-factors-of-vasopressor-induced-symmetrical-peripheral-gangrene
#9
Jung Woo Kwon, Min Ki Hong, Bo Young Park
BACKGROUND: Symmetrical peripheral gangrene (SPG) is an uncommon syndrome showing symmetrical gangrene in acral regions without evidence of large-vessel occlusion or vasculitis. Intravenous vasopressors are frequently used to manage hemodynamically unstable patients. There have been few reports about SPG after using inotropics. However, risk factors for SPG have not been extensively studied. Therefore, the objective of this study was to analyze several cases of SPG and identify risk factors for SPG...
January 9, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29318163/propranolol-induced-circulatory-collapse-in-a-patient-with-thyroid-crisis-and-underlying-thyrocardiac-disease-a-word-of-caution
#10
Hossam Abubakar, Vijendra Singh, Anandita Arora, Sammar Alsunaid
Thyrotoxic crisis or thyroid storm is a severe form of hyperthyroidism and a rare endocrinological emergency. The cornerstones of medical therapy in thyroid storm include decreasing the levels of circulating T3 in the blood as well as inhibiting the hormone's peripheral effects through β-adrenergic blockade. Propranolol is the preferred agent for β-blockade in hyperthyroidism and thyroid storm due to its additional effect of blocking the peripheral conversion of inactive T4 to active form T3. We report a typical clinical scenario where propranolol was administered in treatment of thyroid storm but an uncommon adverse outcome: circulatory failure from cardiogenic shock warranting vasopressor and inotropic support...
October 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/29306223/do-preoperative-oral-carbohydrates-improve-postoperative-outcomesin-patients-undergoing-coronary-artery-bypass-grafts
#11
Ömer Faruk Şavluk, Mehmet Ali Kuşçu, Füsun Güzelmeriç, Mustafa Emre Gürcü, Atakan Erkılınç, Deniz Çevirme, Halide Oğuş, Tuncer Koçak
Background/aim: The aim of this prospective study was to determine whether the preoperative oral intake of carbohydrate-rich drinks by patients undergoing a coronary artery bypass graft attenuates postoperative insulin requirements, improves postoperative patient discomfort, provides inotropic support, shortens the length of the ICU stay, and shortens the duration of postoperative mechanical ventilation. Materials and methods: This randomized prospective clinical study included 152 patients with coronary artery disease who were divided into 4 groups...
December 19, 2017: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/29210058/development-and-internal-validation-of-the-simplified-mortality-score-for-the-intensive-care-unit-sms-icu
#12
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
#13
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
#14
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
#15
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
#16
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...
December 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/29105685/-cardiogenic-shock-from-pharmacological-treatment-to-mechanical-circulatory-support
#17
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
#18
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
#19
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
#20
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) have 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 12, 2017: Journal of Cardiac Failure
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