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https://www.readbyqxmd.com/read/29623382/-the-heart-catheter-table-is-not-the-operating-table-intraindividual-comparison-of-pulmonary-artery-pressures
#1
M U Ziegler, H Reinelt
BACKGROUND: Patients undergoing cardiac surgery need extensive and invasive monitoring, which needs to be individually adapted for each patient and requires a diligent risk-benefit analysis. The use of a pulmonary artery catheter (PAC) seems to be justifiable in certain cases; therefore, the preoperative diagnosis of pulmonary hypertension represents an indication for perioperative monitoring with PAC in the S3 guidelines of the German Society for Anesthesiology and Intensive Care Medicine (DGAI)...
April 5, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29532457/heat-shock-protein-27-and-sex-selective-regulation-of-muscarinic-and-par2-receptor-mediated-vasodilation-differential-sensitivity-to-enos-inhibition
#2
Vivek Krishna Pulakazhi Venu, Mahmoud Saifeddine, Koichiro Mihara, Mahmoud El-Daly, Darrell Belke, Jonathan L E Dean, Edward R O'Brien, Simon A Hirota, Morley D Hollenberg
BACKGROUND AND PURPOSE: Previously, we demonstrated that exogenous Heat Shock Protein 27 (HSP27/gene, HSPB1) treatment of human endothelial progenitor cells (EPCs) increases the synthesis and secretion of VEGF, improves EPC-migration/re-endothelialization and decreases neo-intima formation, suggesting a role for HSPB1 in regulating EPC function. We hypothesized that HSPB1 could also affect mature endothelial cells (ECs) to alter EC-mediated vasoreactivity in vivo. Our work focused on eNOS/NO-dependent relaxation caused by acetylcholine and the coagulation pathway-activated receptor, proteinase-activated receptor-2 (PAR2)...
March 12, 2018: British Journal of Pharmacology
https://www.readbyqxmd.com/read/29520693/alteration-of-heat-shock-protein-20-expression-in-preeclamptic-patients-and-its-effect-in-vascular-and-coagulation-function
#3
Fanfan Li, Mengzhou He, Meitao Yang, Yao Fan, Yun Chen, Xi Xia, Yin Xie, Dongrui Deng
Preeclampsia (PE) is a pregnancy-specific, multi-system disorder and the leading cause of maternal and perinatal morbidity and mortality in obstetrics worldwide. Excessive vasoconstriction and dysregulated coagulation function are closely associated with PE. Heat shock protein 20 (HSP20) is ubiquitously expressed under normal physiological conditions and has important roles in vascular dilatation and suppression of platelet aggregation. However, the role of HSP20 in the pathogenesis of PE remains unclear. In this study, we collected chorionic plate resistance arteries (CPAs) and serum from 118 healthy pregnant women and 80 women with PE and detected the levels of HSP20 and its phosphorylated form...
March 9, 2018: Frontiers of Medicine
https://www.readbyqxmd.com/read/29520277/adrenomedullin-and-adrenomedullin-targeted-therapy-as-treatment-strategies-relevant-for-sepsis
#4
REVIEW
Christopher Geven, Matthijs Kox, Peter Pickkers
Sepsis remains a major medical challenge, for which, apart from improvements in supportive care, treatment has not relevantly changed over the last few decades. Vasodilation and vascular leakage play a pivotal role in the development of septic shock, with vascular leakage being caused by disrupted endothelial integrity. Adrenomedullin (ADM), a free circulating peptide involved in regulation of endothelial barrier function and vascular tone, is implicated in the pathophysiology of sepsis. ADM levels are increased during sepsis, and correlate with extent of vasodilation, as well as with disease severity and mortality...
2018: Frontiers in Immunology
https://www.readbyqxmd.com/read/29449632/inducible-nitric-oxide-synthase-during-the-late-phase-of-sepsis-is-associated-with-hypothermia-and-immune-cell-migration
#5
Yudai Takatani, Kenji Ono, Hiromi Suzuki, Masato Inaba, Makoto Sawada, Naoyuki Matsuda
Hypothermia is a significant sign of sepsis, which is associated with poor prognosis, but few mechanisms underlying the regulation of hypothermia are known. Inducible nitric oxide synthase (iNOS) is a key inflammatory mediator of sepsis. However, the therapeutic benefit of iNOS inhibition in sepsis is still controversial, and requires elucidation in an accurate model system. In this study, wild-type (WT) mice showed temperature drops in a biphasic manner at the early and late phase of sepsis, and all mice died within 48 h of sepsis...
February 14, 2018: Laboratory Investigation; a Journal of Technical Methods and Pathology
https://www.readbyqxmd.com/read/29376560/inotropic-agents-and-vasodilator-strategies-for-the-treatment-of-cardiogenic-shock-or-low-cardiac-output-syndrome
#6
REVIEW
Julia Schumann, Eva C Henrich, Hellen Strobl, Roland Prondzinsky, Sophie Weiche, Holger Thiele, Karl Werdan, Stefan Frantz, Susanne Unverzagt
BACKGROUND: Cardiogenic shock (CS) and low cardiac output syndrome (LCOS) as complications of acute myocardial infarction (AMI), heart failure (HF) or cardiac surgery are life-threatening conditions. While there is a broad body of evidence for the treatment of people with acute coronary syndrome under stable haemodynamic conditions, the treatment strategies for people who become haemodynamically unstable or develop CS remain less clear. We have therefore summarised here the evidence on the treatment of people with CS or LCOS with different inotropic agents and vasodilative drugs...
January 29, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29329694/management-of-refractory-vasodilatory-shock
#7
REVIEW
Jacob C Jentzer, Saraschandra Vallabhajosyula, Ashish K Khanna, Lakhmir S Chawla, Laurence W Busse, Kianoush B Kashani
Refractory shock is a lethal manifestation of cardiovascular failure defined by an inadequate hemodynamic response to high doses of vasopressor medications. Approximately 7% of critically ill patients will develop refractory shock, with short-term mortality exceeding 50%. Refractory vasodilatory shock develops from uncontrolled vasodilation and vascular hyporesponsiveness to endogenous vasoconstrictors, causing failure of physiologic vasoregulatory mechanisms. Standard approaches to the initial management of shock include fluid resuscitation and initiation of norepinephrine...
January 9, 2018: Chest
https://www.readbyqxmd.com/read/29324626/vascular-effects-of-adrenomedullin-and-the-anti-adrenomedullin-antibody-adrecizumab-in-sepsis
#8
Christopher Geven, Andreas Bergmann, Matthijs Kox, Peter Pickkers
Sepsis remains a major scientific and medical challenge, for which, apart from significant refinements in supportive therapy, treatment has barely changed over the last few decades. During sepsis, both vascular tone and vascular integrity are compromised, and contribute to the development of shock. The free circulating peptide adrenomedullin (ADM) is involved in regulation of the endothelial barrier function and tone of blood vessels. Several animal studies have shown that ADM administration improves outcome of sepsis...
January 10, 2018: Shock
https://www.readbyqxmd.com/read/29324187/shock-associated-cardiac-arrest-vasodilator-therapy-may-help
#9
Guillaume Debaty, Marine Paul, Alain Cariou
No abstract text is available yet for this article.
April 1, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29276674/upfront-triple-combination-therapy-induced-pulmonary-edema-in-a-case-of-pulmonary-arterial-hypertension-associated-with-sjogren-s-syndrome
#10
Kimikazu Takeuchi, Kazuhiko Nakayama, Mitsumasa Okano, Naoki Tamada, Hideya Suehiro, Yuto Shinkura, Kenichi Yanaka, Hiroyuki Onishi, Hidekazu Tanaka, Toshiro Shinke, Noriaki Emoto, Ken-Ichi Hirata
Clinical efficacy of combination therapy using vasodilators for pulmonary arterial hypertension (PAH) is well established. However, information on its safety are limited. We experienced a case of primary Sjogren's syndrome associated with PAH where the patient developed pulmonary edema immediately after the introduction of upfront triple combination therapy. Although the combination therapy successfully stabilized her pre-shock state, multiple ground glass opacities (GGO) emerged. We aborted the dose escalation of epoprostenol and initiated continuous furosemide infusion and noninvasive positive pressure ventilation (NPPV), but this did not prevent an exacerbation of pulmonary edema...
2018: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/29261735/docosahexaenoic-acid-but-not-eicosapentaenoic-acid-improves-septic-shock-induced-arterial-dysfunction-in-rats
#11
Alexandra Boivin, Mélanie Burban, Raphaël Clere-Jehl, Pierrick Le Borgne, Hamid Merdji, Cyril Auger, Valérie Schini-Kerth, Ferhat Meziani, Julie Helms
INTRODUCTION: Long chain n-3 fatty acid supplementation may modulate septic shock-induced host response to pathogen-induced sepsis. The composition of lipid emulsions for parenteral nutrition however remains a real challenge in intensive care, depending on their fatty acid content. Because they have not been assessed yet, we aimed at determining the respective effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) during septic shock-induced vascular dysfunction. METHODS: In a peritonitis-induced septic shock model, rats were infused with EPA, DHA, an EPA/DHA mixture or 5% dextrose (D5) during 22 hours...
2017: PloS One
https://www.readbyqxmd.com/read/29244522/pulmonary-vasodilator-therapy-in-shock-associated-cardiac-arrest
#12
Ryan W Morgan, Robert M Sutton, Michael Karlsson, Andrew J Lautz, Constantine D Mavroudis, William P Landis, Yuxi Lin, Sejin Jeong, Nancy Craig, Vinay M Nadkarni, Todd J Kilbaugh, Robert A Berg
RATIONALE: Many in-hospital cardiac arrests are precipitated by hypotension, often associated with systemic inflammation. These patients are less likely to be successfully resuscitated and novel approaches to their treatment are needed. OBJECTIVES: To determine if the addition of inhaled nitric oxide (iNO) to hemodynamic-directed cardiopulmonary resuscitation (HD-CPR) would improve short-term survival from cardiac arrest associated with shock and systemic inflammation...
December 15, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29176374/intraoperative-vasoplegia-methylene-blue-to-the-rescue
#13
Sharon L McCartney, Lorent Duce, Kamrouz Ghadimi
PURPOSE OF REVIEW: To evaluate the efficacy, dosing, and safety of methylene blue (MTB) in perioperative vasoplegic syndrome (VS). RECENT FINDINGS: Vasoplegic syndrome is a state of persistent hypotension with elevated cardiac output, low filling pressures, and low systemic vascular resistance (SVR). It occurs in up to 25% of patients undergoing cardiac surgery with cardiopulmonary bypass, can last up to 72 h, and is associated with a high mortality rate. MTB has been found to increase SVR and decrease vasopressor requirements in vasoplegic syndrome by inhibiting nitric oxide synthase, thus limiting the generation of nitric oxide, while inhibiting activation of soluble guanylyl cyclase and preventing vasodilation...
February 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29173076/non-occlusive-mesenteric-ischemia-two-case-reports-and-a-short-review-of-the-literature
#14
Georges Versyck, Charles de Gheldere, Patrick Vanclooster
INTRODUCTION: Non-occlusive mesenteric ischemia (NOMI) is an infrequent cause of acute mesenteric ischemia with atypical symptoms and a high mortality. PATIENTS AND METHODS: We report two cases of NOMI characterized by their difference in etiology, treatment and outcome. RESULTS: In the first case, the patient developed NOMI after septic shock, she was successfully treated with surgery. The second patient experienced two episodes of cardiac arrest followed by NOMI...
November 25, 2017: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/29169658/-symmetrical-peripheral-gangrene-4-cases
#15
F Smaoui, M Koubaa, K Rekik, Y Mejdoub, S Mezghani, I Maaloul, A Hammami, C Marrakchi, M Ben Jemaa
BACKGROUND: Symmetric peripheral gangrene (SPG) is a symmetrical distal ischemic lesion on at least 2 or more extremities in the absence of proximal arterial obstruction and vasculitis. It is a rare and severe clinical entity. The aim of this study was to describe clinical symptoms, etiological agents and the management of SPG through a series of 4 cases. PATIENTS AND METHODS: We included all cases of SPG hospitalized between 2000 and 2014. The inclusion criterion was the presence of distal ischemic damage at two or more sites in the absence of large vessel obstruction...
November 20, 2017: Annales de Dermatologie et de Vénéréologie
https://www.readbyqxmd.com/read/29149941/pathophysiology-of-septic-shock
#16
REVIEW
James A Russell, Barret Rush, John Boyd
Fundamental features of septic shock are vasodilation, increased permeability, hypovolemia, and ventricular dysfunction. Vasodilation owing to increased nitric oxide and prostaglandins is treated with vasopressors (norepinephrine first). Increased permeability relates to several pathways (Slit/Robo4, vascular endothelial growth factor, angiopoietin 1 and 2/Tie2 pathway, sphingosine-1-phosphate, and heparin-binding protein), some of which are targets for therapies. Hypovolemia is common and crystalloid is recommended for fluid resuscitation...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29110153/protection-by-mtor-inhibition-on-zymosan-induced-systemic-inflammatory-response-and-oxidative-nitrosative-stress-contribution-of-mtor-mek1-erk1-2-ikk%C3%AE-i%C3%AE%C2%BAb-%C3%AE-nf-%C3%AE%C2%BAb-signalling-pathway
#17
Seyhan Sahan-Firat, Meryem Temiz-Resitoglu, Demet Sinem Guden, Sefika Pinar Kucukkavruk, Bahar Tunctan, Ayse Nihal Sari, Zumrut Kocak, Kafait U Malik
Mammalian target of rapamycin (mTOR), a serine/threonine kinase regulate variety of cellular functions including cell growth, differentiation, cell survival, metabolism, and stress response, is now appreciated to be a central regulator of immune responses. Because mTOR inhibitors enhanced the anti-inflammatory activities of regulatory T cells and decreased the production of proinflammatory cytokines by macrophages, mTOR has been a pharmacological target for inflammatory diseases. In this study, we examined the role of mTOR in the production of proinflammatory and vasodilator mediators in zymosan-induced non-septic shock model in rats...
February 2018: Inflammation
https://www.readbyqxmd.com/read/28966921/echocardiographic-evaluation-of-hemodynamics-in-neonates-and-children
#18
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/28949404/the-role-of-syk-i%C3%A4-b-%C3%AE-nf-%C3%A4-b-pathway-activation-in-the-reversal-effect-of-bay-61-3606-a-selective-syk-inhibitor-on-hypotension-and-inflammation-in-a-rat-model-of-zymosan-induced-non-septic-shock
#19
Demet Unsal, Meltem Kacan, Meryem Temiz-Resitoglu, Demet S Guden, Belma Korkmaz, Ayse N Sari, Cuneyt K Buharalioglu, Hatice Yildirim-Yaroglu, Lulufer Tamer-Gumus, Bahar Tunctan, Kafait U Malik, Seyhan Sahan-Firat
Spleen tyrosine kinase (Syk), a non-receptor tyrosine kinase, plays an important role in allergic diseases and inflammation. Syk triggers several intracellular signalling cascades including Toll-like receptor signalling to activate inflammatory responses following fungal infection but the role of this enzyme in zymosan (ZYM)-induced non-septic shock and its impacts on hypotension and inflammation in rats is not well understood. This study was conducted to determine the effects of Syk inhibition on ZYM-induced alterations in the expression and/or activities of Syk, inhibitor ĸB (IĸB)-α, and nuclear factor-ĸB (NF-ĸB) p65...
February 2018: Clinical and Experimental Pharmacology & Physiology
https://www.readbyqxmd.com/read/28948299/-cardiogenic-shock-current-evidence
#20
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...
December 2017: Herz
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