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REVIEW
Yevgeniy Khariton, Ossama Abou Hassan, Jaime A Hernandez-Montfort
PURPOSE OF REVIEW: The following review is intended to provide a summary of contemporary cardiogenic shock (CS) profiling and diagnostic strategies, including biomarker and hemodynamic-based (invasive and noninvasive) monitoring, discuss clinical differences in presentation and trajectory between acute myocardial infarction (AMI)-CS and heart failure (HF)-CS, describe transitions to native heart recovery and heart replacement therapies with a focus on tailored management and emerging real-world data, and emphasize trends in team-based initiatives and interventions for cardiogenic shock including the integration of protocol-driven care...
March 1, 2023: Current Opinion in Cardiology
#22
RANDOMIZED CONTROLLED TRIAL
Nathan I Shapiro, Ivor S Douglas, Roy G Brower, Samuel M Brown, Matthew C Exline, Adit A Ginde, Michelle N Gong, Colin K Grissom, Douglas Hayden, Catherine L Hough, Weixing Huang, Theodore J Iwashyna, Alan E Jones, Akram Khan, Poying Lai, Kathleen D Liu, Chadwick D Miller, Katherine Oldmixon, Pauline K Park, Todd W Rice, Nancy Ringwood, Matthew W Semler, Jay S Steingrub, Daniel Talmor, B Taylor Thompson, Donald M Yealy, Wesley H Self
BACKGROUND: Intravenous fluids and vasopressor agents are commonly used in early resuscitation of patients with sepsis, but comparative data for prioritizing their delivery are limited. METHODS: In an unblinded superiority trial conducted at 60 U.S. centers, we randomly assigned patients to either a restrictive fluid strategy (prioritizing vasopressors and lower intravenous fluid volumes) or a liberal fluid strategy (prioritizing higher volumes of intravenous fluids before vasopressor use) for a 24-hour period...
February 9, 2023: New England Journal of Medicine
#23
REVIEW
Marc Leone, Sharon Einav, Elio Antonucci, François Depret, Ines Lakbar, Ignacio Martin-Loeches, Patrick M Wieruszewski, Sheila Nainan Myatra, Ashish K Khanna
Early initiation of a multimodal treatment strategy in the management of vasopressors during septic shock has been advocated to reduce delays in restoring adequate organ perfusion and to mitigate side effects associated with the administration of high-dose catecholamines. We provide a review that summarises the pathophysiology of vasodilation, the physiologic response to the vascular response, and the different drugs used in this situation, focusing on the need to combine early different vasopressors. Fluid loading being insufficient for counteracting vasoplegia, norepinephrine is usually the first-line vasopressor used to restore hemodynamics...
June 2023: Anaesthesia, Critical Care & Pain Medicine
#24
REVIEW
Daniel De Backer, Maurizio Cecconi, Michelle S Chew, Ludhmila Hajjar, Xavier Monnet, Gustavo A Ospina-Tascón, Marlies Ostermann, Michael R Pinsky, Jean-Louis Vincent
Although guidelines provide excellent expert guidance for managing patients with septic shock, they leave room for personalization according to patients' condition. Hemodynamic monitoring depends on the evolution phase: salvage, optimization, stabilization, and de-escalation. Initially during the salvage phase, monitoring to identify shock etiology and severity should include arterial pressure and lactate measurements together with clinical examination, particularly skin mottling and capillary refill time. Low diastolic blood pressure may trigger vasopressor initiation...
December 1, 2022: Critical Care: the Official Journal of the Critical Care Forum
#25
REVIEW
Andrea Crosignani, Stefano Spina, Francesco Marrazzo, Stefania Cimbanassi, Manu L N G Malbrain, Niels Van Regenmortel, Roberto Fumagalli, Thomas Langer
Patients with acute pancreatitis (AP) often require ICU admission, especially when signs of multiorgan failure are present, a condition that defines AP as severe. This disease is characterized by a massive pancreatic release of pro-inflammatory cytokines that causes a systemic inflammatory response syndrome and a profound intravascular fluid loss. This leads to a mixed hypovolemic and distributive shock and ultimately to multiorgan failure. Aggressive fluid resuscitation is traditionally considered the mainstay treatment of AP...
October 17, 2022: Annals of Intensive Care
#26
REVIEW
Michael R Pinsky, Maurizio Cecconi, Michelle S Chew, Daniel De Backer, Ivor Douglas, Mark Edwards, Olfa Hamzaoui, Glenn Hernandez, Greg Martin, Xavier Monnet, Bernd Saugel, Thomas W L Scheeren, Jean-Louis Teboul, Jean-Louis Vincent
Hemodynamic monitoring is the centerpiece of patient monitoring in acute care settings. Its effectiveness in terms of improved patient outcomes is difficult to quantify. This review focused on effectiveness of monitoring-linked resuscitation strategies from: (1) process-specific monitoring that allows for non-specific prevention of new onset cardiovascular insufficiency (CVI) in perioperative care. Such goal-directed therapy is associated with decreased perioperative complications and length of stay in high-risk surgery patients...
September 28, 2022: Critical Care: the Official Journal of the Critical Care Forum
#27
REVIEW
Timo Mayerhöfer, Andrew D Shaw, Christian J Wiedermann, Michael Joannidis
The administration of fluids is one of the most common interventions in the intensive care unit. The effects and side effects of intravenous fluids depend on the amount administered and their specific composition. Intravenous fluid solutions are either considered crystalloids (for example 0.9% saline, lactated Ringer's solution) or colloids (artificial colloids such as gelatins, and albumin). This narrative review summarizes the physiological principles of fluid therapy and reviews the most important studies on crystalloids, artificial colloids and albumin in the context of critically ill patients...
June 30, 2023: Nephrology, Dialysis, Transplantation
#28
REVIEW
Wayne L Miller
Fluid volume homeostasis in health and heart failure (HF) requires a complex interaction of 2 systems, the intravascular and interstitial-lymphatic circulations. With the development of HF both the intravascular and interstitial compartments undergo variable degrees of volume remodeling which can include significant expansion. This reflects the impact of multiple pathophysiologic mechanisms on both fluid compartments which initially play a compensatory role to stabilize intravascular circulatory integrity but with progression in HF can evolve to produce the various manifestations of volume overload and clinical HF congestion...
September 20, 2022: Journal of the American Heart Association
#29
REVIEW
Eduardo R Argaiz, Philippe Rola, Korbin H Haycock, Frederik H Verbrugge
Despite the widespread use of intravenous fluids in acute kidney injury (AKI), solid evidence is lacking. Intravenous fluids mainly improve AKI due to true hypovolaemia, which is difficult to discern at the bedside unless it is very pronounced. Empiric fluid resuscitation triggered only by elevated serum creatinine levels or oliguria is frequently misguided, especially in the presence of fluid intolerance syndromes such as increased extravascular lung water, capillary leak, intra-abdominal hypertension, and systemic venous congestion...
November 2, 2022: European Heart Journal. Acute Cardiovascular Care
#30
REVIEW
Rafael de la Espriella, Marta Cobo, Enrique Santas, Frederik H Verbrugge, Marat Fudim, Nicolas Girerd, Gema Miñana, José Luis Górriz, Antoni Bayés-Genís, Julio Núñez
Congestion plays a major role in the pathogenesis, presentation, and prognosis of heart failure and is an important therapeutic target. However, its severity and organ and compartment distribution vary widely among patients, illustrating the complexity of this phenomenon. Although clinical symptoms and signs are useful to assess congestion and manage volume status in individual patients, they have limited sensitivity and do not allow identification of congestion phenotype. This leads to diagnostic uncertainty and hampers therapeutic decision-making...
January 2023: Revista Española de Cardiología
#31
REVIEW
Daniel De Backer, Nadia Aissaoui, Maurizio Cecconi, Michelle S Chew, André Denault, Ludhmila Hajjar, Glenn Hernandez, Antonio Messina, Sheila Nainan Myatra, Marlies Ostermann, Michael R Pinsky, Jean-Louis Teboul, Philippe Vignon, Jean-Louis Vincent, Xavier Monnet
In critically ill patients, fluid infusion is aimed at increasing cardiac output and tissue perfusion. However, it may contribute to fluid overload which may be harmful. Thus, volume status, risks and potential efficacy of fluid administration and/or removal should be carefully evaluated, and monitoring techniques help for this purpose. Central venous pressure is a marker of right ventricular preload. Very low values indicate hypovolemia, while extremely high values suggest fluid harmfulness. The pulmonary artery catheter enables a comprehensive assessment of the hemodynamic profile and is particularly useful for indicating the risk of pulmonary oedema through the pulmonary artery occlusion pressure...
October 2022: Intensive Care Medicine
#32
REVIEW
Aarne Feldheiser, Simon Gelman, Michelle Chew, Matthias Stopfkuchen-Evans
No abstract text is available yet for this article.
June 1, 2021: European Journal of Anaesthesiology
#33
RANDOMIZED CONTROLLED TRIAL
Tine S Meyhoff, Peter B Hjortrup, Jørn Wetterslev, Praleene Sivapalan, Jon H Laake, Maria Cronhjort, Stephan M Jakob, Maurizio Cecconi, Marek Nalos, Marlies Ostermann, Manu Malbrain, Ville Pettilä, Morten H Møller, Maj-Brit N Kjær, Theis Lange, Christian Overgaard-Steensen, Björn A Brand, Marie Winther-Olesen, Jonathan O White, Lars Quist, Bo Westergaard, Andreas B Jonsson, Carl J S Hjortsø, Nick Meier, Thomas S Jensen, Janus Engstrøm, Lars Nebrich, Nina C Andersen-Ranberg, Jacob V Jensen, Neeliya A Joseph, Lone M Poulsen, Louise S Herløv, Christoffer G Sølling, Susan K Pedersen, Kurt K Knudsen, Therese S Straarup, Marianne L Vang, Helle Bundgaard, Bodil S Rasmussen, Søren R Aagaard, Thomas Hildebrandt, Lene Russell, Morten H Bestle, Martin Schønemann-Lund, Anne C Brøchner, Claes F Elvander, Søren K L Hoffmann, Michael L Rasmussen, Yvonne K Martin, Fredrik F Friberg, Herman Seter, Tayyba N Aslam, Sigrid Ådnøy, Philipp Seidel, Kristian Strand, Bror Johnstad, Eva Joelsson-Alm, Jens Christensen, Christian Ahlstedt, Carmen A Pfortmueller, Martin Siegemund, Massimiliano Greco, Jaroslav Raděj, Miroslav Kříž, Doug W Gould, Kathy M Rowan, Paul R Mouncey, Anders Perner
BACKGROUND: Intravenous fluids are recommended for the treatment of patients who are in septic shock, but higher fluid volumes have been associated with harm in patients who are in the intensive care unit (ICU). METHODS: In this international, randomized trial, we assigned patients with septic shock in the ICU who had received at least 1 liter of intravenous fluid to receive restricted intravenous fluid or standard intravenous fluid therapy; patients were included if the onset of shock had been within 12 hours before screening...
June 30, 2022: New England Journal of Medicine
#34
REVIEW
Etienne J Couture, Lars Grønlykke, André Y Denault
PURPOSE OF REVIEW: Right ventricular dysfunction has an important impact on the perioperative course of cardiac surgery patients. Recent advances in the detection and monitoring of perioperative right ventricular dysfunction will be reviewed here. RECENT FINDINGS: The incidence of right ventricular dysfunction in cardiac surgery has been associated with unfavorable outcomes. New evidence supports the use of a pulmonary artery catheter in cardiogenic shock. The possibility to directly measure right ventricular pressure by transducing the pacing port has expanded its use to track changes in right ventricular function and to detect right ventricular outflow tract obstruction...
June 1, 2022: Current Opinion in Critical Care
#35
REVIEW
Mahmoud A Ammar, Abdalla A Ammar, Patrick M Wieruszewski, Brittany D Bissell, Micah T Long, Lauren Albert, Ashish K Khanna, Gretchen L Sacha
Septic shock remains a health care concern associated with significant morbidity and mortality. The Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock recommend early fluid resuscitation and antimicrobials. Beyond initial management, the guidelines do not provide clear recommendations on appropriate time to initiate vasoactive therapies and corticosteroids in patients who develop shock. This review summarizes the literature regarding time of initiation of these interventions. Clinical data regarding time of initiation of these therapies in relation to shock onset, sequence of treatments with regard to each other, and clinical markers evaluated to guide initiation are summarized...
May 30, 2022: Annals of Intensive Care
#36
REVIEW
Xavier Monnet, Rui Shi, Jean-Louis Teboul
Although the administration of fluid is the first treatment considered in almost all cases of circulatory failure, this therapeutic option poses two essential problems: the increase in cardiac output induced by a bolus of fluid is inconstant, and the deleterious effects of fluid overload are now clearly demonstrated. This is why many tests and indices have been developed to detect preload dependence and predict fluid responsiveness. In this review, we take stock of the data published in the field over the past three years...
May 28, 2022: Annals of Intensive Care
#37
REVIEW
Romain Persichini, Christopher Lai, Jean-Louis Teboul, Imane Adda, Laurent Guérin, Xavier Monnet
Venous return is the flow of blood from the systemic venous network towards the right heart. At steady state, venous return equals cardiac output, as the venous and arterial systems operate in series. However, unlike the arterial one, the venous network is a capacitive system with a high compliance. It includes a part of unstressed blood, which is a reservoir that can be recruited via sympathetic endogenous or exogenous stimulation. Guyton's model describes the three determinants of venous return: the mean systemic filling pressure, the right atrial pressure and the resistance to venous return...
May 24, 2022: Critical Care: the Official Journal of the Critical Care Forum
#38
REVIEW
Patrick M Wieruszewski, Ashish K Khanna
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2022. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2022 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 .
March 22, 2022: Critical Care: the Official Journal of the Critical Care Forum
#39
REVIEW
Wojciech Weigl, Jan Adamski, Dariusz Onichimowski, Piotr Nowakowski, Bodo Wagner
A growing body of evidence shows that some septic patients experience fluid overload, which leads to an increased number of serious complications and death. This is because the majority of septic patients are fluid non-responders. Therefore, a reliable distinction of which patient would benefit from fluid boluses is crucial in current sepsis mana-gement. Several methods used to assess fluid responsiveness have been developed. The principle of "dynamic" measurements (in contrast to static indices such as central venous pressure) involves the induction of a change in cardiac preload and the measurement of its effect on stroke volume...
2022: Anaesthesiology Intensive Therapy
#40
REVIEW
Yaqi Hu, Aaron Lim
PURPOSE OF REVIEW: The purpose of this review is to look at the current evidence on the consequences of intraoperative hypotension and discuss improvements that can be implemented for its prevention. RECENT FINDINGS: Literature continues to supply convincing evidence that even brief periods of intraoperative hypotension are associated with increased perioperative morbidity and mortality. Recent randomized controlled trial showed intraoperative early use of vasopressor and maintaining blood pressure within tight ranges improves outcomes...
April 1, 2022: Current Opinion in Anaesthesiology
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