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Cardiogenic shock

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By Jason Mann No BS pulmonary critical care fellow
Anthony S McLean
Echocardiography is pivotal in the diagnosis and management of the shocked patient. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied.In the acute situation a basic study often yields immediate results allowing for the initiation of therapy, while a follow-up advanced study brings the advantage of further refining the diagnosis and providing an in-depth hemodynamic assessment. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available...
August 20, 2016: Critical Care: the Official Journal of the Critical Care Forum
Bruno Levy, Olivier Bastien, Bendjelid Karim, Karim Benjelid, Alain Cariou, Tahar Chouihed, Alain Combes, Alexandre Mebazaa, Bruno Megarbane, Patrick Plaisance, Alexandre Ouattara, Christian Spaulding, Christian Splaulding, Jean-Louis Teboul, Fabrice Vanhuyse, Thierry Boulain, Kaldoun Kuteifan
Unlike for septic shock, there are no specific international recommendations regarding the management of cardiogenic shock (CS) in critically ill patients. We present herein recommendations for the management of cardiogenic shock in adults, developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF)), with the participation the French Society of Anesthesia and Intensive Care (SFAR), the French Cardiology Society (SFC), the French Emergency Medicine Society (SFMU), and the French Society of Thoracic and Cardiovascular Surgery (SFCTCV)...
December 2015: Annals of Intensive Care
Jonathan Wiesen, Moshe Ornstein, Adriano R Tonelli, Venu Menon, Rendell W Ashton
The need to provide invasive mechanical ventilatory support to patients with myocardial infarction and acute left heart failure is common. Despite the large number of patients requiring mechanical ventilation in this setting, there are remarkably few data addressing the ideal mode of respiratory support in such patients. Although there is near universal acceptance regarding the use of non-invasive positive pressure ventilation in patients with acute pulmonary oedema, there is more concern with invasive positive pressure ventilation owing to its more significant haemodynamic impact...
December 2013: Heart: Official Journal of the British Cardiac Society
Stephen Westaby, Kyriakos Anastasiadis, George M Wieselthaler
This Review explores contemporary circulatory support in profound postinfarction cardiogenic shock. Frequently, death is the only alternative to implantation of a blood pump, so prospective randomized trials of device versus medical treatment are unacceptable and evidence is derived from clinical experience. Irrespective of ACC/AHA and European guidelines, no study has shown survival benefit for the intra-aortic balloon pump in patients with established shock. In the past 10 years, the safety and durability of mechanical blood pumps has improved considerably...
April 2012: Nature Reviews. Cardiology
Ramford Ng, Yerem Yeghiazarians
Cardiogenic shock is often a devastating consequence of acute myocardial infarction (MI) and portends to significant mortality and morbidity. Despite improvements in expediting the time to treatment and enhancements in available medical therapy and reperfusion techniques, cardiogenic shock remains the most common cause of mortality following MI. Post-MI cardiogenic shock most commonly occurs as a consequence of severe left ventricular dysfunction. Right ventricular (RV) MI must also be considered. Mechanical complications including acute mitral regurgitation, ventricular septal rupture, and ventricular free-wall rupture can also lead to cardiogenic shock...
May 2013: Journal of Intensive Care Medicine
Jose Nativi-Nicolau, Craig H Selzman, James C Fang, Josef Stehlik
PURPOSE OF REVIEW: The natural history of cardiogenic shock has improved significantly with the utilization of revascularization and mechanical circulatory support. Despite the interest in identifying new pharmacological agents, the medical therapy to restore perfusion is limited by their side-effects and no solid evidence about improving outcomes. In this article, we review the current pharmacological agents utilized during cardiogenic shock. RECENT FINDINGS: Inotropes and vasopressors are widely used to improve hemodynamics acutely; however, reliable information regarding comparative efficacy of individual agents is lacking...
May 2014: Current Opinion in Cardiology
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