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Shock, microcirculation, inotropes

M Lipcsey, M Castegren, R Bellomo
We present a review of the hemodynamic management of septic shock. Although substantial amount of evidence is present in this area, most key decisions on the management of these patients remain dependent on physiological reasoning and on pathophysiological principles rather than randomized controlled trials. During primary (early) resuscitation, restoration of adequate arterial pressure and cardiac output using fluids and vasopressor and/or inotropic drugs is guided by basic hemodynamic monitoring and physical examination in the emergency department...
November 2015: Minerva Anestesiologica
Corstiaan A den Uil, Wim K Lagrand, Martin van der Ent, Koen Nieman, Ard Struijs, Lucia S D Jewbali, Alina A Constantinescu, Peter E Spronk, Maarten L Simoons
AIM: To investigate the effects of inotropic agents on parameters of tissue perfusion in patients with cardiogenic shock. METHODS AND RESULTS: Thirty patients with cardiogenic shock were included. Patients received dobutamine, enoximone, or norepinephrine. We performed hemodynamic measurements at baseline and after titration of the inotropic agent until cardiac index (CI) ≥ 2.5 L.min-1.m(-2) or mixed-venous oxygen saturation (SvO2) ≥ 70% (dobutamine or enoximone), and mean arterial pressure (MAP) ≥ 70 mmHg (norepinephrine)...
2014: PloS One
Rajgopal Shenoy, Namrata Agarwal, Umesh Goneppanavar, Anitha Shenoy, Ankur Sharma
A 30 year-old gentleman presented to casualty with history of pain abdomen for six days, fever and decreased urine output since two days. He was in a state of septic shock and was diagnosed to have intestinal perforation. His peripheral pulses were not palpable except for the femoral and brachial vessels. Despite fluid resuscitation, he needed infusion of high doses of dopamine and noradrenaline to maintain his blood pressure. He was operated for repair of perforation. On the first postoperative day, in the intensive care unit, vasopressin infusion was added in view of persistent hypotension...
June 2013: Indian Journal of Surgery
Peter Onody, Rita Stangl, Andras Fulop, Oliver Rosero, David Garbaisz, Zsolt Turoczi, Gabor Lotz, Zoltan Rakonczay, Zsolt Balla, Viktor Hegedus, Laszlo Harsanyi, Attila Szijarto
INTRODUCTION: Temporary occlusion of the hepatoduodenal ligament leads to an ischemic-reperfusion (IR) injury in the liver. Levosimendan is a new positive inotropic drug, which induces preconditioning-like adaptive mechanisms due to opening of mitochondrial KATP channels. The aim of this study was to examine possible protective effects of levosimendan in a rat model of hepatic IR injury. MATERIAL AND METHODS: Levosimendan was administered to male Wistar rats 1 hour (early pretreatment) or 24 hours (late pretreatment) before induction of 60-minute segmental liver ischemia...
2013: PloS One
Xavier Repessé, Cyril Charron, Antoine Vieillard-Baron
The meta-analysis of Huang and coworkers failed to find any evidence for a protective effect of a decreased left ventricular (LV) ejection fraction (EF). These results have to be interpreted with caution since in most studies included in the meta-analysis patients with LV systolic dysfunction received inotropic drugs. We have some arguments suggesting that such a treatment may improve macrocirculation and microcirculation and finally prognosis. This paper allows us to clarify the meaning of LV function in septic shock patients...
2013: Critical Care: the Official Journal of the Critical Care Forum
Ryan C Arnold, R Phillip Dellinger, Joseph E Parrillo, Michael E Chansky, Vincent E Lotano, Jonathan V McCoy, Alan E Jones, Nathan I Shapiro, Steven M Hollenberg, Stephen Trzeciak
PURPOSE: Recent studies reported that microcirculatory blood flow alterations occur in patients with circulatory shock independent of arterial pressure but typically lack baseline microcirculatory data before the insult and after recovery. We selected cardiopulmonary bypass (CPB) patients with expected and rapidly reversible hemodynamic instability to test the hypothesis that microcirculatory alterations can occur independent of mean arterial pressure (MAP). METHODS: Prospective observational study using sidestream darkfield videomicroscopy to measure sublingual microcirculatory flow preoperative (PRE), postoperatively after CPB (POST), and after recovery (REC)...
October 2012: Journal of Critical Care
Dilek Memiş, Mehmet Turan Inal, Necdet Sut
BACKGROUND: Septic shock is the leading causes of death in intensive care units. In addition to generous fluid administration, inotropic agents are commonly used to improve cardiac output. The effects of inotropic agents on regional blood flow remains unknown. OBJECTIVE: The aim of this study was to assess the effects of levosimendan vs dobutamine added to dopamine on liver functions assessed using noninvasive liver function monitoring (LiMON) in patients with septic shock...
June 2012: Journal of Critical Care
Anke P C Top, Can Ince, Neelke de Meij, Monique van Dijk, Dick Tibboel
OBJECTIVE: To investigate the time course and predictive value of microvascular alterations in children with severe sepsis. DESIGN: Single-center, prospective observational study. SETTING: Intensive care unit of a level III university children's hospital. PATIENTS: Patients with septic shock, requiring the administration of fluid and vasopressor agents and/or inotropes after the correction of hypovolemia, who were intubated and ventilated, were included...
January 2011: Critical Care Medicine
Martin W Dünser, Walter R Hasibeder, Volker Wenzel, Andreas Meier-Hellmann
Current therapy of septic/vasodilatory cardiovascular failure includes volume resuscitation and infusion of inotropic and vasopressor agents. Norepinephrine is the first-line vasoconstrictor, and can stabilize hemodynamic variables in most patients. Nonetheless, irreversible cardiovascular failure which is resistant to conventional hemodynamic therapies still is the main cause of death in patients with severe sepsis and septic shock. In such advanced, catecholamine-resistant shock states, arginine-vasopressin (AVP) has repeatedly caused an increase in mean arterial blood pressure, a decrease in toxic norepinephrine-dosages, as well as further beneficial hemodynamic, endocrinologic and renal effects...
November 2006: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Michael Schroth, Christian Plank, Udo Meissner, Klaus-Peter Eberle, Michael Weyand, Robert Cesnjevar, Jörg Dötsch, Wolfgang Rascher
OBJECTIVES: Hypertonic-hyperoncotic solutions are used for the improvement of micro- and macrocirculation in various types of shock. In pediatric intensive care medicine, controlled, randomized studies with hypertonic-hyperoncotic solutions are lacking. Hypertonic-hyperoncotic solutions may improve cardiac function in children. The primary objective of this controlled, randomized, blinded study was to evaluate the hemodynamic effects and safety of hypertonic-hyperoncotic solution infusions in children shortly after open-heart surgery for congenital cardiac disease...
July 2006: Pediatrics
M Chierego, C Verdant, D De Backer
The recent onset of orthogonal polarization spectral (OPS) imaging techniques has allowed the direct visualization of the microcirculation at the bedside of critically ill patients. A systematic review with particular emphasis on recent findings and implications in pathophysiological processes is presented. Using OPS techniques various investigators have observed microcirculatory alterations in critically ill patients, and especially in patients with severe sepsis and septic shock. These alterations include a decrease in vessel density and an increased proportion of non perfused or intermittently perfused capillaries, and these alterations can be fully reversed by the topical application of acetylcholine...
April 2006: Minerva Anestesiologica
J L Vincent, D De Backer
Vasoactive agents are commonly required in the management of septic shock not only to restore a sufficient tissue perfusion pressure but also to increase blood flow and oxygen delivery to the organs. Importantly, vasoactive agents are no substitute for fluid therapy. Defining end points for therapy remains difficult. These should be, above all, clinical. Even though the gut may play an important role in the development of multiple organ failure, the use of gastric tonometry to guide therapy cannot be recommended at this time...
2001: Seminars in Respiratory and Critical Care Medicine
H Schwertz, U Müller-Werdan, R Prondzinsky, K Werdan, M Buerke
Cardiogenic shock is characterized by inadequate organ and tissue perfusion, due to cardiac dysfunction, predominantly following acute myocardial infarction. Mortality rates for patients with cardiogenic shock remain high, ranging from 50-70 % despite effective therapy. Rapid diagnostics, aggressive therapeutic approach (invasive or surgical revascularisation) and pharmacological support are currently used to improve the clinical outcome and survival. In the first line commonly sympathomimetics like dopamine, dobutamine, epinephrine and norepinephrine are used for the pharmacological treatment...
September 10, 2004: Deutsche Medizinische Wochenschrift
Luzius B Hiltebrand, Vladimir Krejci, Gisli H Sigurdsson
BACKGROUND: Insufficient blood flow to the splanchnic organs is believed to be an important contributory factor for the development of organ failure after septic shock. It has been suggested that increasing systemic flow also may improve splanchnic blood flow in septic patients. The aim of this study was to compare the effects of three commonly used inotropic agents, dopamine, dobutamine, and dopexamine, on systemic (cardiac index), regional (superior mesenteric artery), and local (micro-circulatory) blood flow during septic shock in pigs...
May 2004: Anesthesiology
A Meier-Hellman, G Burgard
The extreme disturbance of hemodynamics in shock leads to a minimized oxygen delivery to several vital organs. If this state is not rapidly lifted, a multi-organ-failure can occur. In addition to the removal of the underlying causes, for example, bleeding or septic focus, measures must be started to stabilize hemodynamics. In most cases shock can be successfully treated with standard therapeutic interventions including the use of crystalloid or colloid solutions as well as the infusion of inotropes or vasopressors...
March 2004: Der Internist
A N Laggner
Patients in circulatory shock are being treated in emergency as well as in intensive care units. Despite different resources in personnel and technical equipment in both areas, patient management has to follow standardized protocols. Diagnosis of shock has to be based upon objective parameters (lactate, pH, standard bicarbonate, arterial blood pressure, central venous pressure, cardiac output). Aim of shock treatment is restoration of adequate tissue perfusion with the use of fluid and red blood cell replacement, vasoconstrictors, inotropics, substances improving microcirculation, and mechanical circulatory support...
March 2004: Der Internist
G Montrucchio, G Alloatti, G Camussi
Platelet-activating factor (PAF) is a phospholipid mediator that belongs to a family of biologically active, structurally related alkyl phosphoglycerides. PAF acts via a specific receptor that is coupled with a G protein, which activates a phosphatidylinositol-specific phospholipase C. In this review we focus on the aspects that are more relevant for the cell biology of the cardiovascular system. The in vitro studies provided evidence for a role of PAF both as intercellular and intracellular messenger involved in cell-to-cell communication...
October 2000: Physiological Reviews
A F Suffredini
OBJECTIVE: To review the clinical manifestations and mechanisms of cardiac dysfunction in septic shock. METHODS: Literature review of selected clinical studies and animal models. RESULTS: Depressed myocardial contractile function is a common consequence of severe infections. Bacterial factors, in conjunction with host inflammatory mediators, produce a profile of reversible cardiac dysfunction manifested by a decrease in ventricular ejection fraction, ventricular dilatation, and increased cardiac output...
September 26, 1998: Schweizerische Medizinische Wochenschrift
F Sztark, J P Gékière, P Dabadie
Haemodynamic effects of hypertonic saline solutions (HSS) have been extensively studied in animals and humans. Hypertonic sodium chloride (7.5%, 2,500 mOsm.L-1) either alone or combined with colloids, remains the standard solution. The haemodynamic response of HSS observed during treatment of hypovolaemic shock is explained by 1) an increase in preload due to the expansion of the plasma volume and a musculocutaneous vasoconstriction and 2) a decrease in systemic vascular resistance and afterload. A myocardial stimulation has been shown in various experimental conditions and in humans...
1997: Annales Françaises D'anesthèsie et de Rèanimation
F Christ, I B Gartside, W J Kox, J Gamble
Mercury in silastic strain gauge plethysmography (MSG) is a noninvasive method for assessing microvascular parameters in peripheral limbs. MSG allows measurement of capillary filtration coefficient (Kf), isovolumetric venous pressure (Pvi), venous pressure (Pv) and arterial inflow (Qa) into the limb, respectively. We used MSG in combination with invasive monitoring techniques (pulmonary artery flotation catheters and arterial catheters) to study 36 critically ill patients in either hemorrhagic or septic shock...
October 1993: Infusionstherapie und Transfusionsmedizin
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