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Early use of vasopressor

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https://www.readbyqxmd.com/read/28893702/risk-factors-associated-with-perioperative-myocardial-infarction-in-major-open-vascular-surgery
#1
Danielle C Sutzko, Elizabeth A Andraska, Andrea T Obi, Peter K Henke, Nicholas H Osborne
BACKGROUND: Among patients undergoing non-cardiac surgery, major vascular surgery is associated with a high risk of perioperative myocardial infarction (MI). Currently there are no perioperative MI risk calculators accounting for intraoperative and postoperative risk factors in vascular surgery patients. We aimed to investigate specific risk factors for perioperative MI after major open vascular surgery to determine which patients are at highest risk of MI, and the association of perioperative MI with perioperative transfusion...
September 8, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28876693/continuation-of-feeds-in-the-unstable-burns-patient
#2
A L Rooi, A Muganza, E A Ndobe, M Nel
BACKGROUND: Early enteral nutrition (EEN) and the continuation of enteral nutrition (EN) are critical factors in burn patients, who typically have higher nutritional needs due to their post-injury hypercatabolic state and their additional need for nutrients to aid in the healing of wounds and skin grafts. In the critically ill patient, EN is the preferred mode of administration; however, controversy exists regarding the concomitant use of EN and intravenous vasopressor agents in the haemodynamically unstable patient...
June 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28873333/role-of-echocardiography-in-reducing-shock-reversal-time-in-pediatric-septic-shock-a-randomized-controlled-trial
#3
Ahmed A El-Nawawy, Aly M Abdelmohsen, Hadir M Hassouna
OBJECTIVE: To evaluate the role of echocardiography in reducing shock reversal time in pediatric septic shock. METHODS: A prospective study conducted in the pediatric intensive care unit (PICU) of a tertiary care teaching hospital from September 2013 to May 2016. Ninety septic shock patients were randomized in a 1:1 ratio for comparing the serial echocardiography-guided therapy in the study group with the standard therapy in the control group regarding clinical course, timely treatment, and outcomes...
September 2, 2017: Jornal de Pediatria
https://www.readbyqxmd.com/read/28857849/advanced-percutaneous-mechanical-circulatory-support-devices-for-cardiogenic-shock
#4
P Elliott Miller, Michael A Solomon, Dorothea McAreavey
OBJECTIVES: To review temporary percutaneous mechanical circulatory support devices for the treatment of cardiogenic shock, including current evidence, contraindications, complications, and future directions. DATA SOURCES: A MEDLINE search was conducted with MeSH terms: cardiogenic shock, percutaneous mechanical circulatory support, extracorporeal membrane oxygenation, Impella, and TandemHeart. STUDY SELECTION: Selected publications included randomized controlled trial data and observational studies describing experience with percutaneous mechanical circulatory support in cardiogenic shock...
August 28, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28851407/restricted-fluid-resuscitation-in-sepsis-associated-hypotension-refresh-study-protocol-for-a-pilot-randomised-controlled-trial
#5
Stephen P J Macdonald, David McD Taylor, Gerben Keijzers, Glenn Arendts, Daniel M Fatovich, Frances B Kinnear, Simon G A Brown, Rinaldo Bellomo, Sally Burrows, John F Fraser, Edward Litton, Juan Carlos Ascencio-Lane, Matthew Anstey, David McCutcheon, Lisa Smart, Ioana Vlad, James Winearls, Bradley Wibrow
BACKGROUND: Guidelines recommend an initial intravenous (IV) fluid bolus of 30 ml/kg isotonic crystalloid for patients with sepsis and hypotension. However, there is a lack of evidence from clinical trials to support this. Accumulating observational data suggest harm associated with the injudicious use of fluids in sepsis. There is currently equipoise regarding liberal or restricted fluid-volume resuscitation as first-line treatment for sepsis-related hypotension. A randomised trial comparing these two approaches is, therefore, justified...
August 29, 2017: Trials
https://www.readbyqxmd.com/read/28820036/efficacy-and-safety-of-the-early-addition-of-vasopressin-to-norepinephrine-in-septic-shock
#6
Drayton A Hammond, Julia Cullen, Jacob T Painter, Kelsey McCain, Oktawia A Clem, Amy L Brotherton, Divyan Chopra, Nikhil Meena
BACKGROUND: Delays in achievement of target mean arterial pressure (MAP) have been associated with increased mortality in patients with septic shock. Vasopressin may be added to norepinephrine to raise MAP or decrease norepinephrine dosage. The purpose of this study was to determine whether early initiation of vasopressin to norepinephrine resulted in a reduced time to target MAP compared to norepinephrine monotherapy. METHODS: This retrospective cohort study compared early addition of vasopressin within 4 hours of septic shock onset to norepinephrine versus initial norepinephrine monotherapy in medically, critically ill patients with septic shock admitted from May 2014 to October 2015...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28814247/fluid-and-medication-considerations-in-the-traumatized-patient
#7
Amita Misir
This article reviews fluid therapy and medications in pediatric trauma. For resuscitation in the setting of hemorrhagic shock, isotonic crystalloid solution is the first-line agent of choice. Colloid solutions offer no additional benefit, introduce possible increased risks and cost more than crystalloids. Blood products, starting with pRBCs, should be introduced after 20-40 ml/kg of crystalloid has been administered if there is ongoing need for volume replacement. The use of a massive transfusion protocol of 1:1:1 (if >30 kg) or 30:20:20 (if <30 kg) of pRBCs:FFP:platelets is suggested after an initial 30 ml/kg of pRBcs have been administered...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28807037/selepressin-a-novel-selective-vasopressin-v1a-agonist-is-an-effective-substitute-for-norepinephrine-in-a-phase-iia-randomized-placebo-controlled-trial-in-septic-shock-patients
#8
James A Russell, Jean-Louis Vincent, Anne Louise Kjølbye, Håkan Olsson, Allan Blemings, Herbert Spapen, Peder Carl, Pierre-Francois Laterre, Lars Grundemar
BACKGROUND: Vasopressin is widely used for vasopressor support in septic shock patients, but experimental evidence suggests that selective V1A agonists are superior. The initial pharmacodynamic effects, pharmacokinetics, and safety of selepressin, a novel V1A-selective vasopressin analogue, was examined in a phase IIa trial in septic shock patients. METHODS: This was a randomized, double-blind, placebo-controlled multicenter trial in 53 patients in early septic shock (aged ≥18 years, fluid resuscitation, requiring vasopressor support) who received selepressin 1...
August 15, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28760474/impact-of-postoperative-liver-dysfunction-on-survival-after-left-ventricular-assist-device-implantation
#9
Kaustav Majumder, John R Spratt, Christopher T Holley, Samit S Roy, Rebecca J Cogswell, Kenneth Liao, Ranjit John
BACKGROUND: Liver dysfunction in left ventricular assist device (LVAD) recipients is common both before and after implantation. Postoperative liver dysfunction (PLD) develops in some LVAD recipients without preoperative liver dysfunction. The aim of this study was to assess clinical outcomes in such patients. METHODS: Records of all patients undergoing implantation of a HeartMate II (HM II, St. Jude Medical, Inc, Minneapolis, MN) LVAD at a single center at the University of Minnesota from January 2005 through June 2014 were analyzed...
July 28, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28719490/identification-of-hypotensive-emergency-department-patients-with-cardiogenic-etiologies
#10
Daniel J Henning, Kathleen E Kearney, M Kennedy Hall, Claudius Mahr, Nathan I Shapiro, Graham Nichol
OBJECTIVE: Identify predictors of cardiogenic etiology among Emergency Department (ED) patients with hypotension, and use these predictors to create a clinical tool to discern cardiogenic etiology of hypotension. METHODS: This secondary analysis evaluated a prospective cohort of consecutive patients with hypotension in an urban, academic, tertiary care ED from November 2012 to September 2013. We included adults with hypotension, defined as a new vasopressor requirement, systolic blood pressure (SBP) < 90 mmHg after at least 1L of crystalloid or 2 units packed red blood cells, or SBP < 90 mmHg and fluids withheld due to concern for fluid overload...
July 17, 2017: Shock
https://www.readbyqxmd.com/read/28694703/secondary-sclerosing-cholangitis-in-critically-ill-patients-current-perspectives
#11
REVIEW
Hafsteinn O Gudnason, Einar S Björnsson
Secondary sclerosing cholangitis (SSC) is a term used for a group of chronic cholestatic disease affecting the intra- and/or extrahepatic biliary tree with inflammation and progressive stricture formation, which can lead to biliary cirrhosis. A newly recognized form of SSC is secondary sclerosing cholangitis in critically ill patients (SSC-CIP). Pathogenesis is believed to involve ischemic injury of intrahepatic bile ducts associated with prolonged hypotension, vasopressors administration, and/or mechanical ventilation in patients treated in the intensive care unit (ICU)...
2017: Clinical and Experimental Gastroenterology
https://www.readbyqxmd.com/read/28669923/hematopoietic-cell-transplantation-specific-comorbidity-index-predicts-morbidity-and-mortality-in-autologous-stem-cell-transplantation
#12
Mariano Berro, Jorge A Arbelbide, Maria M Rivas, Ana Lisa Basquiera, Gonzalo Ferini, Adriana Vitriu, Cecilia Foncuberta, Nicolas Fernandez Escobar, Alejandro Requejo, Vera Milovic, Sebastian Yantorno, Milagros Szelagoswki, Juliana Martinez Rolon, Gonzalo Bentolila, Juan Jose Garcia, Pablo Garcia, Gaston Caeiro, Martin Castro, Gregorio Jaimovich, Silvina Palmer, Jose I Trucco, Lucia A Bet, Bronwen E Shaw, Gustavo D Kusminsky
The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) score is a useful tool to assess the risk for nonrelapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation. Although the HCT-CI has been investigated in autologous stem cell transplantation (ASCT), its use is limited. To improve on the current use of the HCT-CI score on the morbidity and mortality after ASCT, we assessed the 100-day morbidity defined as orotracheal intubation (OTI), dialysis or shock (vasopressors need), 100-day NRM, early composite morbidity-mortality (combined endpoint that included any previous endpoints), and long-term NRM...
June 29, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28623891/systolic-blood-pressure-variability-in-patients-with-early-severe-sepsis-or-septic-shock-a-prospective-cohort-study
#13
Yi Tang, Jeff Sorenson, Michael Lanspa, Colin K Grissom, V J Mathews, Samuel M Brown
BACKGROUND: Severe sepsis and septic shock are often lethal syndromes, in which the autonomic nervous system may fail to maintain adequate blood pressure. Heart rate variability has been associated with outcomes in sepsis. Whether systolic blood pressure (SBP) variability is associated with clinical outcomes in septic patients is unknown. The propose of this study is to determine whether variability in SBP correlates with vasopressor independence and mortality among septic patients. METHODS: We prospectively studied patients with severe sepsis or septic shock, admitted to an intensive care unit (ICU) with an arterial catheter...
June 17, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28529913/critical-care-management-and-intensive-care-unit-outcomes-following-cytoreductive-surgery-with-hyperthermic-intraperitoneal-chemotherapy
#14
Sumit Kapoor, Adel Bassily-Marcus, Rafael Alba Yunen, Parissa Tabrizian, Sabrine Semoin, Joseph Blankush, Daniel Labow, John Oropello, Anthony Manasia, Roopa Kohli-Seth
AIM: To study the early postoperative intensive care unit (ICU) management and complications in the first 2 wk of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: Our study is a retrospective, observational study performed at Icahn School of Medicine at Mount Sinai, quaternary care hospital in New York City. All adult patients who underwent CRS and HIPEC between January 1, 2007 and December 31, 2012 and admitted to ICU postoperatively were studied...
May 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28523028/peripheral-arterial-blood-pressure-versus-central-crterial-blood-pressure-monitoring-in-critically-ill-patients-after-cardio-pulmonary-bypass
#15
Rana Altaf Ahmad, Suhail Ahmad, Anjum Naveed, Mirza Ahmad Raza Baig
OBJECTIVE: To determine the accuracy of peripheral (radial) arterial access as compared to central (femoral) arterial access for measurement of invasive blood pressure (IBP) in critically ill patients after cardiopulmonary bypass. METHODS: Sixty patients (60) who required high inotropic/vasopressor support on weaning from cardio-pulmonary bypass and weaned off in 2(nd) attempt were included in this study. The duration of this study was from June 2015 to August 2016...
March 2017: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/28514322/relationship-between-a-sepsis-intervention-bundle-and-in-hospital-mortality-among-hospitalized-patients-a-retrospective-analysis-of-real-world-data
#16
Priya A Prasad, Erica R Shea, Stephen Shiboski, Mary C Sullivan, Ralph Gonzales, David Shimabukuro
BACKGROUND: Sepsis is a systemic response to infection that can lead to tissue damage, organ failure, and death. Efforts have been made to develop evidence-based intervention bundles to identify and manage sepsis early in the course of the disease to decrease sepsis-related morbidity and mortality. We evaluated the relationship between a minimally invasive sepsis intervention bundle and in-hospital mortality using robust methods for observational data. METHODS: We performed a retrospective cohort study at the University of California, San Francisco, Medical Center among adult patients discharged between January 1, 2012, and December 31, 2014, and who received a diagnosis of severe sepsis/septic shock (SS/SS)...
August 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28506137/elevation-of-serum-park7-and-il-8-levels-is-associated-with-acute-lung-injury-in-patients-with-severe-sepsis-septic-shock
#17
Xiao-Wei Liu, Tao Ma, Quan Cai, Li Wang, Hong-Wei Song, Zhi Liu
OBJECTIVE: Methods containing only clinical information fail to meet the needs of prediction of acute lung injury (ALI) because of the relatively low positive predictive value. This study aimed to investigate the feasibility of using biomarkers as predictors of ALI in populations with severe sepsis/septic shock and to explore difference among biomarkers after adjustment for potential confounders. METHODS: Serum specimens were collected from patients with severe sepsis/septic shock (n = 172) presented to the emergency department...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28494827/use-of-placental-umbilical-blood-sampling-for-neonatal-admission-blood-cultures-benefits-challenges-and-strategies-for-implementation
#18
Shannon P Moore, Desi M Newberry, Amy J Jnah
Placental blood remains an underused resource for early neonatal care despite ample evidence that placental blood provides the same clinical decision making information without the need for painful, invasive blood sampling procedures. Potential benefits of placental/umbilical blood sampling (PUBS) for neonatal admission labs include decreases in pain reactivity, rates of anemia, need for blood transfusions, use of vasopressors, and rates of intraventricular hemorrhage. Here, we present a unique case study of a critically ill infant with contradictory blood culture results from PUBS and direct infant sampling...
May 1, 2017: Neonatal Network: NN
https://www.readbyqxmd.com/read/28448605/vasopressor-use-following-traumatic-injury-a-single-center-retrospective-study
#19
Mathieu Hylands, Marie-Pier Godbout, Sandeep K Mayer, William D Fraser, Alain Vanasse, Marc-André Leclair, Alexis F Turgeon, François Lauzier, Emmanuel Charbonney, Vincent Trottier, Tarek S Razek, André Roy, Frédérick D'Aragon, Emilie Belley-Côté, Andrew G Day, Soazig Le Guillan, Robert Sabbagh, François Lamontagne
OBJECTIVES: Vasopressors are not recommended by current trauma guidelines, but recent reports indicate that they are commonly used. We aimed to describe the early hemodynamic management of trauma patients outside densely populated urban centers. METHODS: We conducted a single-center retrospective cohort study in a Canadian regional trauma center. All adult patients treated for traumatic injury in 2013 who died within 24 hours of admission or were transferred to the intensive care unit were included...
2017: PloS One
https://www.readbyqxmd.com/read/28413267/vasopressors-do-they-have-any-role-in-hemorrhagic-shock
#20
REVIEW
Babita Gupta, Neha Garg, Rashmi Ramachandran
The priority in the management of patients with traumatic hemorrhagic shock is to control the bleeding with simultaneous volume resuscitation to maintain adequate tissue perfusion. Fluid replacement remains the mainstay of initial resuscitation in hemorrhagic shock. Traditionally, vasopressors are contraindicated in the early management of hemorrhagic shock due to their deleterious consequences, although vasopressors may have a role in resuscitation when vasoplegic shock ensues and blood pressure cannot be maintained by fluids alone...
January 2017: Journal of Anaesthesiology, Clinical Pharmacology
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