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noradrenaline in sepsis

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
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...
September 16, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
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
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
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
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
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
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
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
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
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
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
Yasir Alhamdi, Simon T Abrams, Zhenxing Cheng, Shengjie Jing, Dunhao Su, Zhiyong Liu, Steven Lane, Ingeborg Welters, Guozheng Wang, Cheng-Hock Toh
OBJECTIVE: To investigate the impact of circulating histones on cardiac injury and dysfunction in a murine model and patients with sepsis. DESIGN: Prospective, observational clinical study with in vivo and ex vivo translational laboratory investigations. SETTING: General ICU and university research laboratory. SUBJECTS: Sixty-five septic patients and 27 healthy volunteers. Twelve-week-old male C57BL/6N mice. INTERVENTIONS: Serial blood samples from 65 patients with sepsis were analyzed, and left ventricular function was assessed by echocardiography...
October 2015: Critical Care Medicine
Sonali Thosani, Montserrat Ayala-Ramirez, Alejandro Román-González, Shouhao Zhou, Nirav Thosani, Annette Bisanz, Camilo Jimenez
OBJECTIVE: Pheochromocytomas (PHs) and sympathetic paragangliomas (PGs) are tumors that produce catecholamines, predisposing patients to cardiovascular disease and gastrointestinal effects such as constipation. OBJECTIVES: i) determine the prevalence of constipation, its risk factors, and its impact on survival; ii) identify whether a systematic combination of fiber, water, and laxatives was effective for treatment of constipation. DESIGN AND METHODS: We retrospectively studied 396 patients with PH/PG diagnosed in 2005-2014...
September 2015: European Journal of Endocrinology
Ronan M G Berg, Ronni R Plovsing, Damian M Bailey, Niels-Henrik Holstein-Rathlou, Kirsten Møller
Vasopressor support is used widely for maintaining vital organ perfusion pressure in septic shock, with implications for dynamic cerebral autoregulation (dCA). This study investigated whether a noradrenaline-induced steady state increase in mean arterial blood pressure (MAP) would enhance dCA following lipopolysaccharide (LPS) infusion, a human-experimental model of the systemic inflammatory response during early sepsis. The dCA in eight healthy males was examined prior to and during an intended noradrenaline-induced MAP increase of approximately 30 mmHg...
July 2015: Clinical and Experimental Pharmacology & Physiology
Bianca Ballarin Albino, André Luis Balbi, Juliana Maria Gera Abrão, Daniela Ponce
Prolonged intermittent renal replacement therapy (PIRRT) has emerged as an alternative to continuous renal replacement therapy in the management of acute kidney injury (AKI) patients. This trial aimed to compare the dialysis complications occurring during different durations of PIRRT sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline doses ranging from 0.3 to 0.7 µg/kg/min. Patients were divided into two groups randomly: in G1, 6-h sessions were performed, and in G2, 10-h sessions were performed...
May 2015: Artificial Organs
Andrzej Kübler, Barbara Adamik, Grażyna Durek, Ewa Mayzner-Zawadzka, Wojciech Gaszyński, Ewa Karpel, Wiesława Duszyńska
BACKGROUND: Severe sepsis remains the most common cause of death in intensive care units (ICUs) according to many epidemiological studies. There are no data in Poland on the extent of severe sepsis cases treated in ICUs. The aim of the study was to analyse the course and outcome of severe sepsis patients treated in Polish ICUs. METHODS: In 2003, the internet-based severe sepsis registry was created as a multicentre observational research project. An online questionnaire was made accessible to ICUs participating in the study...
2015: Anaesthesiology Intensive Therapy
Clara B Lorigados, Suely K Ariga, Tiago R Batista, Irineu T Velasco, Francisco G Soriano
OBJECTIVE: To investigate the role of coronary driving pressure (CDP) in myocardial microcirculatory blood flow during sepsis. We hypothesised that in septic shock there is an impaired autoregulation of microcirculation, and blood flow is totally dependent on CDP. We analysed the effect of lipopolysaccharide (LPS)-induced shock on myocardial microcirculation, separating subendocardial and epicardial areas. We then studied the effect of CDP increases using noradrenaline (NOR) or metaraminol (Aramine [ARA]) on myocardial microcirculation and function, and we analysed the effect of volume infusion on CDP and myocardial function...
March 2015: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Carolyn J Barrett
What is the topic of this review? This review examines the role played by renal sympathetic nerves in the regulation of cardiovascular function, focusing on changes that occur during the development of hypertension and heart failure. What advances does it highlight? While elevated levels of renal sympathetic activity are a feature of many cardiovascular diseases, the relationship is not straightforward, especially in the case of hypertension. This review highlights that before consideration of targeting the renal nerves in the clinical management of cardiovascular diseases it is essential that their role in the development of the disease is established...
April 1, 2015: Experimental Physiology
Sisse R Ostrowski, Shahin Gaïni, Court Pedersen, Pär I Johansson
PURPOSE: To investigate levels, associations between, and predictive value of plasma catecholamines and biomarkers of endothelial damage in patients with acute infectious illness stratified according to infection type and sepsis severity. MATERIAL AND METHODS: This is a post hoc study of plasma samples collected in prospective studies conducted at a department of internal medicine. Plasma catecholamines, syndecan-1, and thrombomodulin were measured. Registration of biochemistry, physiology, and 28- and 90-day mortality was performed...
February 2015: Journal of Critical Care
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