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Peripheral vasopressors

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https://www.readbyqxmd.com/read/29023316/septic-shock-resuscitation-in-the-first-hour
#1
Nicholas Simpson, Francois Lamontagne, Manu Shankar-Hari
PURPOSE OF REVIEW: We reviewed the recent advances in the initial approach to resuscitation of sepsis and septic shock patients. RECENT FINDINGS: Sepsis and septic shock are life-threatening emergencies. Two key interventions in the first hour include timely antibiotic therapy and resuscitation. Before any laboratory results, the need for resuscitation is considered if a patient with suspected infection has low blood pressure (BP) or impaired peripheral circulation found at clinical examination...
October 11, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28980031/-use-of-near-infrared-spectroscopy-for-control-of-limb-perfusion-during-venoarterial-ecmo-treatment-application-and-limitations
#2
T Werner, D Lunz, A Philipp, B Flörchinger, B M Graf, Y A Zausig
Patients undergoing peripheral venoarterial extracorporeal membrane oxygenation have a high risk of lower limb ischemia. In general, regular controls are carried out based on clinical and laboratory parameters in order to quickly detect and treat complications. These controls are challenging due to states of shock, nonpulsatile flow and vasopressor therapy. As additional monitoring the use of near-infrared spectroscopy (NIRS) is described in the literature as being very successful in detecting ischemia. The present article describes the use and possible limitations of NIRS for the diagnostics of peripheral ischemia...
October 4, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28890646/alternative-pharmacological-management-of-vasopressor-extravasation-in-the-absence-of-phentolamine
#3
Michelle Plum, Oussayma Moukhachen
Vasopressor extravasation is a rare adverse drug reaction that can lead to tissue damage, ischemia, and necrosis of the affected area when vasopressors are administered peripherally. Phentolamine, a nonselective, reversible alpha antagonist, is the current standard treatment for this adverse reaction, but it is often unavailable for use. This review seeks to synthesize the available data in order to recommend alternative pharmacological options for use when phentolamine is not available. After an extensive literature search, 16 publications were reviewed...
September 2017: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/28869020/-administration-of-norepinephrine-in-peripheral-venous-catheter-on-surgical-patients
#4
Sophie Amalie Ekeløf, Sarah Ekeløf, Jesper N Bech, Peter Ekeløf
Hypotension is a common event during surgery and can cause serious post-operative complication, but vasoactive drugs can stabilize the cardiovascular system and reduce the risk of post-operative complications. Norepinephrine is an ideal vasopressor. Due to the risk of extravasation and ischaemic tissue damage norepinephrine is often administered via a central venous catheter. Administration of norepinephrine via a peripheral venous catheter may be a safe alternative during surgery, if the drug is administered correctly...
August 21, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28837291/-prehospital-misconceptions
#5
Eduardo Alcouce, Vincent Darioli, Pierre-Nicolas Carron, Mathieu Pasquier
We confronted some of the most prevalent prehospital misconceptions with the available literature. We found that: the diminution of a retrosternal pain following nitrate administration is not predictive of a cardiac origin of the pain ; survival of traumatic cardiac arrest may not be as bad as usually believed ; peripheral venous administration of vasopressors through proximal catheters during short times may be considered as a safe temporary alternative to central venous access ; using the pulse palpation usually lead to an under-estimation of the systolic blood pressure ; applying a pelvic belt at the level of the iliac crests doesn't aggravate an open-book fracture; there is no 90 mmHg threshold values below which mortality increases in traumatic brain injuries...
August 9, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28711369/predicting-failure-to-rescue-after-abdominal-aortic-aneurysm-repair-in-elderly-patients
#6
Caitlin W Hicks, Anna O'Kelly, Tammam Obeid, Satinderjit Locham, Mahmoud B Malas
BACKGROUND: We aim to describe trends in failure to rescue (FTR) among elderly patients undergoing elective open aortic aneurysm repair (OAR) and endovascular aortic aneurysm repair (EVAR). MATERIALS AND METHODS: All patients aged ≥80 y recorded in the Vascular Quality Initiative database (2002-2014) undergoing nonruptured infrarenal AAA repair were included. Primary outcome was FTR, defined as percentage of deaths in patients who had a complication within 30 d of surgery...
September 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28688009/comparing-volume-clamp-method-and-intra-arterial-blood-pressure-measurements-in-patients-with-atrial-fibrillation-admitted-to-the-intensive-or-medium-care-unit
#7
G F N Berkelmans, S Kuipers, B E Westerhof, A M E Spoelstra-de Man, Y M Smulders
International guidelines highlight the importance of blood pressure (BP) in patients with atrial fibrillation (AF). However, BP measurement in AF is complicated by beat-to-beat fluctuation. Automated BP measurement devices are not validated for patients with AF and no consensus exists on how to measure BP in AF manually. Beat-to-beat BP measurement using the volume-clamp method (VCM) could represent a non-invasive method to accurately assess BP, but has not been validated in AF. 31 admitted patients with sustained AF and 10 control patients with sinus rhythm underwent simultaneous intra-arterial and non-invasive BP measurement using a VCM monitor (Nexfin(®), BMEYE, Amsterdam, The Netherlands)...
July 7, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28684125/vasopressor-induced-peripheral-skin-necrosis-after-shock
#8
María Elena Arnáiz-García, Ana María Arnáiz-García, José Francisco Gutiérrez-Diez, José María González-Santos, Aida García-Martín, David Alonso-Peña, Javier Arnáiz
No abstract text is available yet for this article.
July 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/28658134/treprostinil-for-persistent-pulmonary-hypertension-of-the-newborn-with-early-onset-sepsis-in-preterm-infant-2-case-reports
#9
Bo Young Park, Sung-Hoon Chung
RATIONALE: Persistent pulmonary hypertension of the newborn (PPHN) is a syndrome of failed circulatory adaptation at birth with persisting increased pulmonary vascular resistance that is associated with high mortality rates especially in preterm infants. PATIENT CONCERNS: We reported 2 cases of PPHN in preterm infants with respiratory distress syndrome and early onset sepsis refractory to therapy with vasopressors, inotropes, and inhaled nitric oxide (iNO), in whom treatment with treprostinil was successful...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28580075/role-of-vasopressin-in-current-anesthetic-practice
#10
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/28577744/orthostatic-hypotension-a-review
#11
Adrien Joseph, Ruben Wanono, Martin Flamant, Emmanuelle Vidal-Petiot
Orthostatic hypotension, defined by a drop in blood pressure of at least 20mmHg for systolic blood pressure and at least 10mmHg for diastolic blood pressure within 3minutes of standing up, is a frequent finding, particularly in elderly patients. It is associated with a significant increase in morbidity and mortality. Although it is often multifactorial, the first favoring factor is medications. Other etiologies are divided in neurogenic orthostatic hypotension, characterized by autonomic failure due to central or peripheral nervous system disorders, and non-neurogenic orthostatic hypotension, mainly favoured by hypovolemia...
April 2017: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/28569131/safety-of-phenylephrine-infusion-through-peripheral-intravenous-catheter-in-the-neurological-intensive-care-unit
#12
Sudhir Datar, Eddy Gutierrez, Adam Schertz, Vidula Vachharajani
OBJECTIVE: The traditional approach for infusing vasopressors is to insert central venous catheters, which is associated with several complications. Phenylephrine is a commonly used vasopressor in the neurologic intensive care unit (neuro ICU), and due to its modest potency, the risk of local tissue injury from extravasation may be overestimated. The purpose of this study was to evaluate the safety of phenylephrine infusion through peripheral intravenous catheter (PIV) in the neuro ICU...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28543052/norepinephrine-reduces-arterial-compliance-less-than-phenylephrine-when-treating-general-anesthesia-induced-arterial-hypotension
#13
F Vallée, O Passouant, A Le Gall, J Joachim, J Mateo, A Mebazaa, E Gayat
INTRODUCTION: During general anesthesia, arterial hypotension is frequent and may be an important contributor to perioperative morbidity. We assessed the effect of a 5 μg bolus of Norepinephrine (NA) when compared with 50 μg bolus of Phenylephrine (PE) administered to treat hypotension during maintenance anesthesia, on MAP, derived cardiac output and arterial stiffness parameters. METHODS: Patients scheduled for a neurosurgical procedure under general anesthesia were prospectively included...
July 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28523028/peripheral-arterial-blood-pressure-versus-central-crterial-blood-pressure-monitoring-in-critically-ill-patients-after-cardio-pulmonary-bypass
#14
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/28345066/correlation-of-central-venous-pressure-with-venous-blood-gas-analysis-parameters-a-diagnostic-study
#15
Sima Rahim-Taleghani, Alireza Fatemi, Mostafa Alavi Moghaddam, Majid Shojaee, Abdelrahman Ibrahim Abushouk, Mohammad Mehdi Forouzanfar, Alireza Baratloo
OBJECTIVE: This study was conducted to assess the correlation between central venous pressure (CVP) and venous blood gas (VBG) analysis parameters, to facilitate management of severe sepsis and septic shock in emergency department. MATERIAL AND METHODS: This diagnostic study was conducted from January 2014 until June 2015 in three major educational medical centers, Tehran, Iran. For patients selected with diagnosis of septic shock, peripheral blood sample was taken for testing the VBG parameters and the anion gap (AG) was calculated...
March 2017: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28108832/beat-by-beat-assessment-of-cardiac-afterload-using-descending-aortic-velocity-pressure-loop-during-general-anesthesia-a-pilot-study
#16
Fabrice Vallée, Arthur Le Gall, Jona Joachim, Olivier Passouant, Joaquim Matéo, Arnaud Mari, Sandrine Millasseau, Alexandre Mebazaa, Etienne Gayat
Continuous cardiac afterload evaluation could represent a useful tool during general anesthesia (GA) to titrate vasopressor effect. Using beat to beat descending aortic pressure(P)/flow velocity(U) loop obtained from esophageal Doppler and femoral pressure signals might allow to track afterload changes. Methods We defined three angles characterizing the PU loop (alpha, beta and Global After-Load Angle (GALA)). Augmentation index (AIx) and total arterial compliance (Ctot) were measured via radial tonometry. Peripheral Vascular Resistances (PVR) were also calculated...
January 20, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28099636/use-of-reactive-hyperemia-peripheral-arterial-tonometry-and-circulating-biological-markers-to-predict-outcomes-in-sepsis
#17
Vandack Nobre, Thiago Bragança Ataíde, Luisa Caldeira Brant, Clara Rodrigues Oliveira, Lucas Vieira Rodrigues, Antonio Luiz Pinho Ribeiro, Fernanda Barbosa Lopes, Ivan Euclides Saraiva, Marcus Vinícius Andrade
Objective: To evaluate the usefulness and prognostic value of reactive hyperemia - peripheral arterial tonometry in patients with sepsis. Moreover, we investigated the association of reactive hyperemia - peripheral arterial tonometry results with serum levels of certain inflammatory molecules. Methods: Prospective study, conducted in an 18-bed mixed intensive care unit for adults. The exclusion criteria included severe immunosuppression or antibiotic therapy initiated more than 48 hours before assessment...
October 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28077532/modern-hydroxyethyl-starch-and-acute-kidney-injury-after-cardiac-surgery-a-prospective-multicentre-cohort
#18
M Vives, R Callejas, P Duque, G Echarri, D N Wijeysundera, A Hernandez, A Sabate, M Bes-Rastrollo, P Monedero
BACKGROUND: Recent trials have shown hydroxyethyl starch (HES) solutions increase the risk of acute kidney injury (AKI) in critically ill patients. It is uncertain whether these adverse effects also affect surgical patients. We sought to determine the renal safety of modern tetrastarch (6% HES 130/0.4) use in cardiac surgical patients. METHODS: In this multicentre prospective cohort study, 1058 consecutive patients who underwent cardiac surgery from 15th September 2012 to 15th December 2012 were recruited in 23 Spanish hospitals...
October 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28073314/safety-of-the-peripheral-administration-of-vasopressor-agents
#19
Tyler Lewis, Cristian Merchan, Diana Altshuler, John Papadopoulos
Vasopressors are an integral component of the management of septic shock and are traditionally given via a central venous catheter (CVC) due to the risk of tissue injury and necrosis if extravasated. However, the need for a CVC for the management of septic shock has been questioned, and the risk of extravasation and incidence of severe injury when vasopressors are given via a peripheral venous line (PVL) remains poorly defined. We performed a retrospective chart review of 202 patients who received vasopressors through a PVL...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28029485/shenfu-injection-for-improving-cellular-immunity-and-clinical-outcome-in-patients-with-sepsis-or-septic-shock
#20
RANDOMIZED CONTROLLED TRIAL
Ning Zhang, Jianhua Liu, Zeliang Qiu, Yiping Ye, Jian Zhang, Tianzheng Lou
PURPOSE: To assess the efficacy of Shenfu injection (SFI) for enhancing cellular immunity and improving the clinical outcomes of patients with septic shock. METHODS: Patients with sepsis were randomly assigned to receive either SFI at a dose of 100mL every 24hours for 7 consecutive days or a placebo in addition to conventional therapy. The immunologic parameters were collected on days 1, 3, and 7 after the above treatments, and the clinical outcomes were updated for 28days...
January 2017: American Journal of Emergency Medicine
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