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noradrenaline in sepsis

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https://www.readbyqxmd.com/read/29882682/unintended-consequences-fluid-resuscitation-worsens-shock-in-an-ovine-model-of-endotoxemia
#1
Liam Byrne, Nchafatso G Obonyo, Sara D Diab, Kimble R Dunster, Margaret R Passmore, Ai-Ching Boon, Louise See Hoe, Sanne Pedersen, Mohd Hashairi Fauzi, Leticia Pretti Pimenta, Frank Van Haren, Christopher M Anstey, Louise Cullen, John-Paul Tung, Kiran Shekar, Kathryn Maitland, John F Fraser
BACKGROUND: Fluid resuscitation is widely considered a life saving intervention in septic shock however recent evidence has questioned both its safety and efficacy in sepsis. This study sought to compare fluid resuscitation with vasopressors with vasopressors alone in a hyperdynamic model of ovine endotoxemia. METHODS: Endotoxemic shock was induced in sixteen sheep after which they received fluid resuscitation with 40mls/kg of 0.9% saline or commenced haemodynamic support with protocolized noradrenaline and vasopressin...
June 8, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29541878/neural-pathways-involved-in-infection-induced-inflammation-recent-insights-and-clinical-implications
#2
REVIEW
Marion Griton, Jan Pieter Konsman
Although the immune and nervous systems have long been considered independent biological systems, they turn out to mingle and interact extensively. The present review summarizes recent insights into the neural pathways activated by and involved in infection-induced inflammation and discusses potential clinical applications. The simplest activation concerns a reflex action within C-fibers leading to neurogenic inflammation. Low concentrations of pro-inflammatory cytokines or bacterial fragments may also act on these afferent nerve fibers to signal the central nervous system and bring about early fever, hyperalgesia and sickness behavior...
March 14, 2018: Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society
https://www.readbyqxmd.com/read/29438568/haemodynamic-assessment-and-support-in-sepsis-and-septic-shock-in-resource-limited-settings
#3
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...
November 1, 2017: Transactions of the Royal Society of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/28991047/vasopressors-do-not-influence-cerebral-critical-closing-pressure-during-systemic-inflammation-evoked-by-experimental-endotoxemia-and-sepsis-in-humans
#4
Judith Maria Dimphena van den Brule, Roeland Stolk, Elisabeth Janine Vinke, Lex Maxim van Loon, Peter Pickkers, Johannes Gerardus van der Hoeven, Matthijs Kox, Cornelia Wilhelmina Elisabeth Hoedemaekers
AIM: The aim of this study was to investigate the effects of different vasopressors on the cerebral vasculature during experimental human endotoxemia and sepsis. We used the critical closing pressure (CrCP) as a measure of cerebral vascular tone. METHODS: We performed a prospective pilot study, at the intensive care department (ICU) of a tertiary care university hospital in the Netherlands, in 40 healthy male subjects during experimental human endotoxemia (administration of bacterial lipopolysaccharide [LPS]) and in 10 patients with severe sepsis or septic shock...
May 2018: Shock
https://www.readbyqxmd.com/read/28659919/the-%C3%AE-d-endoglucuronidase-heparanase-is-a-danger-molecule-that-drives-systemic-inflammation-and-correlates-with-clinical-course-after-open-and-endovascular-thoracoabdominal-aortic-aneurysm-repair-lessons-learnt-from-mice-and-men
#5
Lukas Martin, Alexander Gombert, Jianmin Chen, Julia Liebens, Julia Verleger, Johannes Kalder, Gernot Marx, Michael Jacobs, Christoph Thiemermann, Tobias Schuerholz
Thoracoabdominal aortic aneurysm (TAAA) is a highly lethal disorder requiring open or endovascular TAAA repair, both of which are rare, but extensive and complex surgical procedures associated with a significant systemic inflammatory response and high post-operative morbidity and mortality. Heparanase is a β-d-endoglucuronidase that remodels the endothelial glycocalyx by degrading heparan sulfate in many diseases/conditions associated with systemic inflammation including sepsis, trauma, and major surgery. We hypothesized that (a) perioperative serum levels of heparanase and heparan sulfate are associated with the clinical course after open or endovascular TAAA repair and (b) induce a systemic inflammatory response and renal injury/dysfunction in mice...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28589286/extracorporeal-cytokine-elimination-as-rescue-therapy-in-refractory-septic-shock-a-prospective-single-center-study
#6
Sigrun Friesecke, Stephanie-Susanne Stecher, Stefan Gross, Stephan B Felix, Axel Nierhaus
Sepsis is the most common cause of death in medical intensive care units (ICU). If sepsis progresses to refractory septic shock, mortality may reach 90-100% despite optimum current therapy. Extracorporeal cytokine adsorption in addition to regular therapy was studied prospectively in refractory septic shock patients on a medical ICU. Refractory shock was defined as increasing vasopressor dose required to maintain mean arterial blood pressure above 65 mmHg or increasing lactate levels despite protocol-guided shock therapy for 6 h...
September 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/28520696/an-ovine-model-of-hyperdynamic-endotoxemia-and-vital-organ-metabolism
#7
Liam Byrne, Nchafatso G Obonyo, Sara Diab, Kimble Dunster, Margaret Passmore, Ai Ching Boon, Louise See Hoe, Karen Hay, Frank Van Haren, John-Paul Tung, Louise Cullen, Kiran Shekar, Kathryn Maitland, John F Fraser
BACKGROUND: Animal models of endotoxemia are frequently used to understand the pathophysiology of sepsis and test new therapies. However, important differences exist between commonly used experimental models of endotoxemia and clinical sepsis. Animal models of endotoxemia frequently produce hypodynamic shock in contrast to clinical hyperdynamic shock. This difference may exaggerate the importance of hypoperfusion as a causative factor in organ dysfunction. This study sought to develop an ovine model of hyperdynamic endotoxemia and assess if there is evidence of impaired oxidative metabolism in the vital organs...
January 2018: Shock
https://www.readbyqxmd.com/read/28494911/levosimendan-does-not-provide-mortality-benefit-over-dobutamine-in-adult-patients-with-septic-shock-a-meta-analysis-of-randomized-controlled-trials
#8
REVIEW
Sulagna Bhattacharjee, Kapil D Soni, Souvik Maitra, Dalim K Baidya
OBJECTIVES: Despite of advancement in intensive care medicine, sepsis and septic shock carry a high mortality. Levosimendan, an inodilator, may be promising for septic shock patients with myocardial dysfunction; however, firm evidence is lacking. In this meta- analysis of randomized controlled trials, levosimendan has been compared with dobutamine in adult patients with sepsis and septic shock. DESIGN: Meta-analysis of randomized controlled trial. SETTING: Intensive-care unit...
June 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27744568/noradrenaline-in-preterm-infants-with-cardiovascular-compromise
#9
MULTICENTER STUDY
Kirsten Rowcliff, Koert de Waal, Abdel-Latif Mohamed, Tejasvi Chaudhari
Noradrenaline (NA) is beneficial in the treatment of term newborns with cardiovascular compromise due to sepsis or pulmonary hypertension, but experiences with NA in preterm infants are limited. The aim of this study is to describe the efficacy and safety of NA in preterm infants. Patient records of preterm infants ≤32 weeks' gestation admitted to two hospitals between 2004 and 2015 and who received NA were reviewed for perinatal morbidities and mortality. Clinical details were collected at the time of NA use, and response on blood pressure, perfusion and oxygenation was documented as well as possible side effects...
December 2016: European Journal of Pediatrics
https://www.readbyqxmd.com/read/27633962/a-randomized-trial-comparing-terlipressin-and-noradrenaline-in-patients-with-cirrhosis-and-septic-shock
#10
RANDOMIZED CONTROLLED TRIAL
Ashok Choudhury, Chandan K Kedarisetty, Chitranshu Vashishtha, Deepak Saini, Sachin Kumar, Rakhi Maiwall, Manoj K Sharma, Ajeet S Bhadoria, Guresh Kumar, Yogendra K Joshi, Shiv K Sarin
BACKGROUND & AIMS: The choice of vasopressor for treating cirrhosis with septic shock is unclear. While noradrenaline in general is the preferred vasopressor, terlipressin improves microcirculation in addition to vasopressor action in non-cirrhotics. We compared the efficacy and safety of noradrenaline and terlipressin in cirrhotics with septic shock. PATIENTS AND METHODS: Cirrhotics with septic shock underwent open label randomization to receive either terlipressin (n=42) or noradrenaline (n=42) infusion at a titrated dose...
April 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/27390456/acute-kidney-injury-incidence-prognostic-factors-and-outcome-of-patients-in-an-intensive-care-unit-in-a-tertiary-center-a-prospective-observational-study
#11
Sara Korula, Sindhu Balakrishnan, Shyam Sundar, Vergis Paul, Anuroop Balagopal
BACKGROUND AND AIMS: The information regarding the incidence of acute kidney injury (AKI) in medical Intensive Care Units (ICUs) in South India is limited. The aim of the study was to find the incidence, prognostic factors, and outcome of patients with AKI. We also assessed whether only urine output criteria of risk, injury, failure, loss, end (RIFLE) classification can be used to look at the outcome of AKI. PATIENTS AND METHODS: This was a prospective, cross-sectional study of 6 months duration in a 28 bedded medical ICU of a tertiary center...
June 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27271248/left-ventricular-function-during-porcine-resuscitated-septic-shock-with-pre-existing-atherosclerosis
#12
Benedikt L Nußbaum, Oscar McCook, Clair Hartmann, José Matallo, Martin Wepler, Elena Antonucci, Miriam Kalbitz, Markus Huber-Lang, Michael Georgieff, Enrico Calzia, Peter Radermacher, Sebastian Hafner
BACKGROUND: Reversible, depressed cardiac function is frequently encountered during septic shock and commonly called septic cardiomyopathy. Previous studies demonstrated reduced ejection fraction and left ventricular dilatation in both humans and animal models. However, the majority of the studies in humans excluded pre-existing cardiac disease and animal studies were performed on healthy specimen and/or without vasopressor support during sepsis. In order to more closely mimic the actual patients' conditions on intensive care units and to assess the influence of both cardiac comorbidity and vasopressor support on septic cardiomyopathy, we evaluated the left ventricular function in a porcine model of resuscitated septic shock with pre-existing atherosclerosis...
December 2016: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/27076723/does-vasopressin-improve-the-mortality-of-septic-shock-patients-treated-with-high-dose-na
#13
Koichi Ohsugi, Toru Kotani, Satoshi Fukuda, Yoko Sato, Satoshi Toyama, Makoto Ozaki
AIM OF STUDY: In Surviving Sepsis Campaign Guidelines 2012, noradrenalin (NA) is recommended as a first choice vasopressor. Although vasopressin (VP) is recommended for the treatment of NA-resistant septic shock, the optimal parameters for its administration remain unclear. MATERIALS AND METHODS: We conducted a retrospective study to evaluate the clinical outcomes of the administration of VP to adult septic shock patients who were undergoing high-dose NA (≥0.25 μg/kg/min) therapy in our Intensive Care Unit between January 2010 and December 2013...
March 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/26918904/potential-survival-benefit-of-polymyxin-b-hemoperfusion-in-septic-shock-patients-on-continuous-renal-replacement-therapy-a-propensity-matched-analysis
#14
Masao Iwagami, Hideo Yasunaga, Eisei Noiri, Hiromasa Horiguchi, Kiyohide Fushimi, Takehiro Matsubara, Naoki Yahagi, Masaomi Nangaku, Kent Doi
BACKGROUND/AIMS: We assessed the survival benefit of polymyxin B hemoperfusion (PMX) in septic shock patients starting continuous renal replacement therapy (CRRT), who are known to have an increased rate of mortality. METHODS: Adult patients in the Japanese diagnosis procedure combination database satisfying the following criteria were enrolled: hospitalized in 2007-2012; diagnosed as having sepsis; required noradrenaline and/or dopamine; and started CRRT in intensive care unit...
2016: Blood Purification
https://www.readbyqxmd.com/read/26783533/pressor-response-to-noradrenaline-in-the-setting-of-septic-shock-anything-new-under-the-sun-dexmedetomidine-clonidine-a-minireview
#15
REVIEW
A Géloën, C Pichot, S Leroy, C Julien, M Ghignone, C N May, L Quintin
Progress over the last 50 years has led to a decline in mortality from ≈70% to ≈20% in the best series of patients with septic shock. Nevertheless, refractory septic shock still carries a mortality close to 100%. In the best series, the mortality appears related to multiple organ failure linked to comorbidities and/or an intense inflammatory response: shortening the period that the subject is exposed to circulatory instability may further lower mortality. Treatment aims at reestablishing circulation within a "central" compartment (i...
2015: BioMed Research International
https://www.readbyqxmd.com/read/26690796/prevention-and-treatment-of-sepsis-induced-acute-kidney-injury-an-update
#16
Patrick M Honore, Rita Jacobs, Inne Hendrickx, Sean M Bagshaw, Olivier Joannes-Boyau, Willem Boer, Elisabeth De Waele, Viola Van Gorp, Herbert D Spapen
Sepsis-induced acute kidney injury (SAKI) remains an important challenge in critical care medicine. We reviewed current available evidence on prevention and treatment of SAKI with focus on some recent advances and developments. Prevention of SAKI starts with early and ample fluid resuscitation preferentially with crystalloid solutions. Balanced crystalloids have no proven superior benefit. Renal function can be evaluated by measuring lactate clearance rate, renal Doppler, or central venous oxygenation monitoring...
December 2015: Annals of Intensive Care
https://www.readbyqxmd.com/read/26386218/clinical-effects-of-a-longer-duration-of-polymyxin-b-immobilized-fiber-column-direct-hemoperfusion-therapy-for-severe-sepsis-and-septic-shock
#17
Chizuru Yamashita, Yoshitaka Hara, Naohide Kuriyama, Tomoyuki Nakamura, Osamu Nishida
Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) therapy is widely used for the treatment of severe sepsis and septic shock, and is generally performed for 2 h. Although previous studies demonstrated the efficacy of PMX-DHP therapy, it currently remains unclear whether its optimal duration is 2 h. This retrospective study analyzed 37 patients with septic shock who showed a poor clinical response to 2 h of PMX-DHP, and underwent a longer duration of this therapy. The mean duration of PMX-DHP therapy was 15...
August 2015: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/26292920/clinical-management-for-patients-admitted-to-a-critical-care-unit-with-severe-sepsis-or-septic-shock
#18
Wai Keung Cheung, Lai Sheung Chau, Iun Ieng Laurinda Mak, Mei Yi Wong, Sai Leung Wong, Agnes Fung Yee Tiwari
BACKGROUND: The Surviving Sepsis Campaign promotes the use of norepinephrine as the first-line inotropic support for patients presenting with severe sepsis or septic shock in cases of persistent hypotension, despite adequate fluid resuscitation. However, there is little published evidence on how much noradrenaline is administered to such patients when admitted to the intensive care unit (ICU). The authors report the clinical management of this group of patients, with a special focus on the total amount and duration of norepinephrine infusion required...
December 2015: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/26215823/impairment-of-neutrophilic-glucocorticoid-receptor-function-in-patients-treated-with-steroids-for-septic-shock
#19
Maria Bergquist, Catharina Lindholm, Morten Strinnholm, Göran Hedenstierna, Christian Rylander
BACKGROUND: Glucocorticoid (GC) treatment has variable effect in sepsis. This may be explained by decreased expression or function of the glucocorticoid receptor (GR). The aim of this study was to determine GR expression and binding capacity in patients during and after sepsis. METHODS: In this prospective, non-interventional clinical study, peripheral blood and clinical data were collected from 20 adult patients at five timepoints during sepsis and 5-13 months after recovery...
December 2015: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/26215803/calcium-desensitisation-in-late-polymicrobial-sepsis-is-associated-with-loss-of-vasopressor-sensitivity-in-a-murine-model
#20
Benjamin Aj Reddi, John F Beltrame, Richard L Young, David P Wilson
BACKGROUND: Sepsis is characterised by diminished vasopressor responsiveness. Vasoconstriction depends upon a balance: Ca(2+)-dependent myosin light-chain kinase promotes and Ca(2+)-independent myosin light-chain phosphatase (MLCP) opposes vascular smooth muscle contraction. The enzyme Rho kinase (ROK) inhibits MLCP, favouring vasoconstriction. We tested the hypothesis that ROK-dependent MLCP inhibition was attenuated in late sepsis and associated with reduced contractile responses to certain vasopressor agents...
December 2015: Intensive Care Medicine Experimental
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