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Shock, cardiac output, sepsis

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https://www.readbyqxmd.com/read/28743338/-clinical-characteristics-and-prognosis-in-patients-with-high-plasma-level-of-procalcitonin-an-analysis-in-188-patients
#1
Chuli Pan, Wei Cui, Feifei Zhou, Junwei Tu, Xiuhui Lin, Libin Li, Gensheng Zhang
OBJECTIVE: To investigate the clinical characteristics and prognosis of patients with high level of plasma procalcitonin (PCT > 100 μg/L), and to improve the clinician's understanding, diagnosis and treatment of this kind of patients. METHODS: A retrospective study was conducted. The clinical data of patients with plasma PCT over 100 μg/L within 48 hours of admission admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from February 2013 to December 2016 were collected, and the clinical characteristics were analyzed...
July 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28731900/micro-and-macro-circulatory-changes-during-sepsis-and-septic-shock-in-a-rat-model
#2
Tianfeng Hua, Xiaobo Wu, Wei Wang, Hao Li, Jennifer Bradley, Mary Ann Peberdy, Joseph P Ornato, Wanchun Tang
Microcirculation is the motor of sepsis. In the present study, we investigated whether microcirculatory alterations occur prior to changes of systemic hemodynamics in a rat model of cecum ligation and puncture (CLP)-induced sepsis. We further investigated renal microcirculatory changes during sepsis and compared those with buccal microcirculation. Twelve male Sprague-Dawley rats were randomized into a sham control group (n = 6) and a CLP group (n = 6). Perfused microvessel density (PVD) and microvascular flow index (MFI) were evaluated using sidestream dark field (SDF) video microscopy at baseline, 60, 120, 180, 240, 300, and 360 minutes following CLP...
July 20, 2017: Shock
https://www.readbyqxmd.com/read/28580075/role-of-vasopressin-in-current-anesthetic-practice
#3
REVIEW
Keun Suk Park, Kyung Yeon Yoo
Arginine vasopressin (AVP), also known as antidiuretic hormone, is a peptide endogenously secreted by the posterior pituitary in response to hyperosmolar plasma or systemic hypoperfusion states. When administered intravenously, it causes an intense peripheral vasoconstriction through stimulation of V1 receptors on the vascular smooth muscle. Patients in refractory shock associated with severe sepsis, cardiogenic or vasodilatory shock, or cardiopulmonary bypass have inappropriately low plasma levels of AVP ('relative vasopressin deficiency') and supersensitivity to exogenously-administered AVP...
June 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28509668/norepinephrine-in-septic-shock-when-and-how-much
#4
Olfa Hamzaoui, Thomas W L Scheeren, Jean-Louis Teboul
PURPOSE OF REVIEW: Norepinephrine is the first-line agent recommended during resuscitation of septic shock to correct hypotension due to depressed vascular tone. Important clinical issues are the best timing to start norepinephrine, the optimal blood pressure target, and the best therapeutic options to face refractory hypotension when high doses of norepinephrine are required to reach the target. RECENT FINDINGS: Recent literature has reported benefits of early administration of norepinephrine because of the following reasons: profound and durable hypotension is an independent factor of increased mortality, early administration of norepinephrine increases cardiac output, improves microcirculation and avoids fluid overload...
August 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28455289/diminished-responsiveness-to-dobutamine-as-an-inotrope-in-mice-with-cecal-ligation-and-puncture-induced-sepsis-attribution-to-phosphodiesterase-4-upregulation
#5
COMPARATIVE STUDY
Mari Sakai, Tokiko Suzuki, Kengo Tomita, Shigeyuki Yamashita, Sailesh Palikhe, Kohshi Hattori, Naoki Yoshimura, Naoyuki Matsuda, Yuichi Hattori
Dobutamine has been used in septic shock for many years as an only inotrope, but its benefit has been questioned. We weighed the effects of dobutamine and milrinone as inotropes in mice with cecal ligation and puncture (CLP)-induced polymicrobial sepsis. CLP-induced septic mice exhibited significant cardiac inflammation, as indicated by greatly increased mRNAs of proinflammatory cytokines and robust infiltration of inflammatory cells in the ventricular myocardium. Elevations of plasma cardiac troponin-I showed cardiac injury in CLP mice...
June 1, 2017: American Journal of Physiology. Heart and Circulatory Physiology
https://www.readbyqxmd.com/read/28261505/augmenting-function-for-infarction-from-infection-impella-2-5-for-ischemic-cardiogenic-shock-complicating-sepsis
#6
Praveen George, Mukta C Srivastava, Jonathan Ludmir, Robert M Reed, Semhar Z Tewelde, Anuj Gupta, Michael T McCurdy
Cardiac dysfunction is a common complication of sepsis in individuals with preexisting coronary disease and portends a poor prognosis when progressing to ischemic cardiogenic shock. In this setting, maximal medical therapy in isolation is often inadequate to maintain cardiac output for patients who are poor candidates for immediate revascularization. Furthermore, the use of vasopressors and inotropes increases myocardial demand and may lead to further injury. Percutaneous ventricular assist devices provide a viable option for management of severe shock with multiorgan failure...
2017: Case Reports in Cardiology
https://www.readbyqxmd.com/read/28160954/management-of-sepsis-in-patients-with-pulmonary-arterial-hypertension-in-the-intensive-care-unit
#7
REVIEW
Todd M Tartavoulle
Pulmonary arterial hypertension is a lethal condition, and the management of sepsis in patients with pulmonary arterial hypertension is challenging. As the disease progresses, the right ventricle is susceptible to failure due to a high pulmonary vascular resistance. The limited ability of the right ventricle to increase cardiac output in septic shock makes it difficult to deliver oxygen to the organ and tissues. Intravascular volume replacement and vasoactive drugs should only be considered after a thorough assessment...
March 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27956337/-postsurgical-morbidity-in-pediatric-patients-undergoing-surgery-for-congenital-heart-disease-in-umae-from-yucatan
#8
Addy Castillo-Espínola, Ana Velázquez-Ibarra, Aurea Zetina-Solórzano, Patricia Bolado-García, Gonzalo Gamboa-López
OBJECTIVE: To describe the clinical course of pediatric patients undergoing surgery for congenital heart disease in UMAE from Yucatan. METHODS: Descriptive survey records of pediatric patients congenital heart undergoing surgery for congenital heart disease from November, 1st 2011 to November, 30st 2013. RESULTS: The most frequent heart diseases were the persistence ductus arteriosus (37.6%) and transposition of great vessels. The intensive care stay was 3days (median)...
December 9, 2016: Archivos de Cardiología de México
https://www.readbyqxmd.com/read/27931645/haemodynamic-coherence%C3%A2-%C3%A2-the-relevance-of-fluid-therapy
#9
REVIEW
Philip Arnemann, Laura Seidel, Christian Ertmer
The ultimate goal of fluid therapy is to improve the oxygenation of cells by improving the cardiac output, thus improving microcirculation by optimizing macrocirculation. This haemodynamic coherence is often altered in patients with haemorrhagic shock and sepsis. The loss of haemodynamic coherence is associated with adverse outcomes. It may be influenced by the mechanisms of the underlying disease and properties of different fluids used for resuscitation in these critically ill patients. Monitoring microcirculation and haemodynamic coherence may be an additional tool to predict the response to fluid administration...
December 2016: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/27931643/microvascular-monitoring-do-global-markers-help
#10
REVIEW
Jean-Louis Vincent, Fabio Silvio Taccone
The microcirculation is altered in sepsis, and the degree and persistence of these alterations are associated with outcome. When there are significant alterations of the systemic circulation, as in shock, the microcirculation is always altered. However, sometimes global variables can be restored to normal while the microcirculation remains altered. Monitoring the microcirculation has, therefore, been proposed as a more precise means of assessing the effects of therapy. In this review, we will discuss the limitations of global haemodynamic variables such as mean arterial pressure, cardiac output and mixed venous oxygen saturation as markers of microcirculatory abnormalities...
December 2016: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/27908340/end-points-of-sepsis-resuscitation
#11
REVIEW
John C Greenwood, Clinton J Orloski
Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable and reproducible. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient's overall response to therapy...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27753856/hw-01-4-cardioankle-vascular-index-cavi-in-hypertension
#12
Kohji Shirai
BACKGROUND: The cardio-ankle vascular index (CAVI) is a new arterial stiffness index of the arterial tree from the origin of the aorta to the ankle, and was essentially derived from the stiffness parameterβtheory proposed by Hayashi. The conspicuous feature of CAVI is independency from blood pressure at the time of measurement. AIM: The purpose is to clarify the meaning of CAVI as a surrogate marker of arteriosclerosis, and also the role of CAVI in the blood pressure control system...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27713891/vasoactive-agents-for-the-treatment-of-sepsis
#13
REVIEW
Zhongheng Zhang, Kun Chen
The article describes some commonly used vasoactive agents in patients with septic shock. Depending on their distinct pharmacological properties, their effects on vascular bed and cardiac function are different. For example, dopamine has equivalent effect on heart and vasculature, which can result in increases in cardiac output, mean arterial pressure and heart rate. Dobutamine is considered as inodilator because it has potent effect on cardiac systole and vasculature. Patients with sepsis and septic shock sometimes have coexisting cardiac dysfunction that justifies the use of dobutamine...
September 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27643093/hw-01-4-cardioankle-vascular-index-cavi-in-hypertension
#14
Kohji Shirai
BACKGROUND: The cardio-ankle vascular index (CAVI) is a new arterial stiffness index of the arterial tree from the origin of the aorta to the ankle, and was essentially derived from the stiffness parameterβtheory proposed by Hayashi. The conspicuous feature of CAVI is independency from blood pressure at the time of measurement. AIM: The purpose is to clarify the meaning of CAVI as a surrogate marker of arteriosclerosis, and also the role of CAVI in the blood pressure control system...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27434562/-measurement-of-brachial-artery-velocity-variation-and-inferior-vena-cava-variability-to-estimate-fluid-responsiveness
#15
Weihua Zhu, Linjun Wan, Xiaohong Wan, Gang Wang, Meixian Su, Gengjin Liao, Qingqing Huang
OBJECTIVE: To investigate the accuracy and feasibility of brachial artery peak velocity variation (ΔVpeakbrach) and inferior vena cava variability (VIVC) as indicators of fluid responsiveness in critically ill patients. METHODS: A single-center prospective observation was conducted. The patients on mechanical ventilation with spontaneously breathing admitted to Department of Critical Care Medicine of the Second Affiliated Hospital of Kunming Medical University from June 2013 to August 2015 were enrolled...
August 2016: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/27411452/efficacy-and-safety-of-esmolol-in-treatment-of-patients-with-septic-shock
#16
Wei Du, Xiao-Ting Wang, Yun Long, Da-Wei Liu
BACKGROUND: Previous studies have suggested that β1-receptor blockers benefit septic shock patients. This study aimed to determine whether β1-receptor blockers benefit tissue perfusion in sepsis and to identify parameters to reduce the risk of this drug in sepsis. METHODS: Consecutive septic shock patients were recruited from the Intensive Care Unit of Peking Union Medical College Hospital within 48 h of diagnosis. All patients were hemodynamically stable and satisfactorily sedated with a heart rate (HR) ≥100 beats/min...
July 20, 2016: Chinese Medical Journal
https://www.readbyqxmd.com/read/27378201/the-effects-of-direct-hemoperfusion-using-a-polymyxin-b-immobilized-column-in-a-pig-model-of-severe-pseudomonas-aeruginosa-pneumonia
#17
Gianluigi Li Bassi, Joan Daniel Marti, Eli Aguilera Xiol, Talitha Comaru, Francesca De Rosa, Montserrat Rigol, Silvia Terraneo, Mariano Rinaudo, Laia Fernandez, Miguel Ferrer, Antoni Torres
BACKGROUND: Hemoperfusion through a column containing polymyxin B-immobilized fiber (PMX-HP) is beneficial in abdominal sepsis. We assessed the effects of PMX-HP in a model of severe Pseudomonas aeruginosa pneumonia. METHODS: Eighteen pigs with severe P. aeruginosa pneumonia were mechanically ventilated for 76 h. Pigs were randomized to receive standard treatment with fluids and vasoactive drugs, or standard treatment with two 3-h PMX-HP sessions. Antibiotics against P...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27238916/high-serum-strem-1-correlates-with-myocardial-dysfunction-and-predicts-prognosis-in-septic-patients
#18
Zhenyu Li, Enyuan Zhang, Yipeng Hu, Yi Liu, Bing Chen
OBJECTIVE: This study aimed to evaluate the predictive and prognostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in patients with myocardial dysfunction induced by severe sepsis and septic shock. MATERIALS AND METHODS: A total of 84 patients with severe sepsis and septic shock were enrolled between May 2013 and December 2014.The patients were monitored by pulse indicator continuous cardiac output system and divided into myocardial depression group (cardiac function index [CFI] < 4...
June 2016: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/27177587/speckle-tracking-echocardiography-in-patients-with-septic-shock-a-case-control-study-speckss
#19
Pauline Yeung Ng, Wai Ching Sin, Andrew Kei-Yan Ng, Wai Ming Chan
BACKGROUND: Sepsis-induced myocardial dysfunction is a well-recognized condition and confers worse outcomes in septic patients. Echocardiographic assessment by conventional parameters such as left ventricular ejection fraction (LVEF) is often affected by ongoing changes in preload and afterload conditions. Novel echocardiographic technologies such as speckle tracking echocardiography (STE) have evolved for direct assessment of the myocardial function. We investigate the measurement of myocardial strain by speckle tracking echocardiography for the diagnosis of sepsis-induced myocardial dysfunction...
May 14, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27138843/initiation-or-maintenance-of-beta-blocker-therapy-in-patients-hospitalized-for-acute-heart-failure
#20
COMPARATIVE STUDY
Luiz Carlos Passos, Márcio Galvão Oliveira, Andre Rodrigues Duraes, Thiago Moreira Trindade, Andréa Cristina Costa Barbosa
Background Beta-blockers have been recommended for patients with heart failure and reduced ejection fraction for their long-term benefits. However, the tolerance to betablockers in patients hospitalized with acute heart failure should be evaluated. Objective To estimate the proportion of patients hospitalized with acute heart failure who can tolerate these agents in clinical practice and compare the clinical outcomes of patients who can and cannot tolerate treatment with beta-blockers. Setting Two reference hospitals in cardiology...
August 2016: International Journal of Clinical Pharmacy
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