2,548 research outputs found
Vasopressors in shock: Too early to move away from catecholamines?
No full textAdrenergic and non-adrenergic vasopressor agents can be used to correct hypotension in shock states. For a similar increase in arterial pressure, these agents may be associated with different haemodynamic, metabolic, endocrinological or immunological effects. But how relevant are these differences? Do these affect the outcome of patients with shock? Large-scale randomized trials comparing the effects of different vasopressor agents are scarce. Data on potential alternatives, and especially vasopressin, are even more scarce. Over-interpretation of the data, and especially of data obtained in subgroups, is common. Analysis of subgroups may be useful to address mechanisms and to raise hypotheses. However, subgroup analysis is often biased by confounding factors, especially when subgroup categorization is defined by response to therapy and not by intrinsic patient or disease characteristics. In this issue of the British Journal of Pharmacology, Bracht and colleagues present their interpretation of data from trials comparing vasopressin with noradrenaline in patients with septic shock. Here, we present an alternative interpretation. © 2011 The Authors. British Journal of Pharmacology.SCOPUS: re.jFLWINinfo:eu-repo/semantics/publishe
Clinical management of the cardiovascular failure in sepsis
No full textCardiovascular failure in sepsis involves a combination of hypovolemia, decreased vascular tone, myocardial depression and microcirculatory alterations. Fluids represent the first line therapeutic intervention, with controversy regarding the type of fluid. Recent data indicate that albumin is safe and might even be beneficial in specific subgroups. Starches may be an alternative, although concerns exist on potential detrimental effects on renal function of old generation starches. Trials testing new generation starches are ongoing. When fluids fail to correct hypotension, vasopressor agents are used. Various adrenergic agents increase blood pressure, especially dopamine, noradrenaline and adrenaline, by stimulating alpha-adrenergic receptors. They also variably stimulate beta-adrenergic receptors, increasing cardiac contractility, heart rate, and splanchnic perfusion, but with increased risk of arrhythmias, immunomodulation and increased metabolism. Furthermore, dopamine stimulates dopaminergic receptors, resulting in doubtful effects on splanchnic and renal perfusion, but also in endocrine alterations. Do these pharmacologic differences among the various alpha-adrenergic agents translate into clinical differences? Several randomized trials tested the effects of these agents on outcome. Epinephrine produces more undesired effects than norepinephrine, but no clear cut differences on outcome were observed in underpowered trials. Norepinephrine should be preferred over dopamine, as suggested in one large trial and confirmed in a meta-analysis. Vasopressin may be considered as an alternative or in addition to adrenergic agents. In one large trial, no significant difference in outcome was observed, and the exact role of vasopressin still needs clarification. Finally, various inotropic agents can counteract septic myocardial depression. So far, no study supports their routine use, but these may be justified on an individual basis. © 2013 Bentham Science Publishers.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Assessment of microperfusion in sepsis
No full textMicrocirculatory alterations are frequent in sepsis and different mechanisms can be implied and variously studied. The severity of microvascular alterations is associated with organ dysfunction and mortality. The aim of this review is to make an overview of the most actual and used techniques applied on septic humans. We aimed at focus on the impact of different techniques on the evaluation of patients' management and outcome.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Year in review 2010: Critical Care - cardiology
No full textWe review key research papers in cardiology and intensive care published during 2010 in Critical Care and quote related studies published in other journals if appropriate. Papers were grouped into the following categories: cardiovascular therapies, biomarkers, hemodynamic monitoring, cardiovascular diseases, and microcirculation. © 2011 BioMed Central Ltd.SCOPUS: re.jinfo:eu-repo/semantics/publishe
Why do pulse pressure variations fail to predict the response to fluids in acute respiratory distress syndrome patients ventilated with low tidal volume?
No full textRespiratory-associated variations in stroke volume and pulse pressure are frequently used to predict the response to fluid administration. However, it has been demonstrated that low tidal volume ventilation may limit their use in patients with acute respiratory distress syndrome (ARDS). In this issue, a trial investigates the value of pulse pressure variation to predict fluid responsiveness in a large series of patients with ARDS ventilated according to current guidelines.CommentJournal ArticleSCOPUS: no.jinfo:eu-repo/semantics/publishe
A short history of the European Association of Preventive Cardiology (EAPC)
No full textDe Backer G, Perk J, Wood D, et al. A short history of the European Association of Preventive Cardiology (EAPC). European Journal of Preventive Cardiology . 2022: zwac027.The history of the EAPC is closely related to the history of the European Society of Cardiology (ESC). The ESC decided at the turn of the century to overcome the splitting into 27 topic related Working Groups with great differences in size and activities and to create a new organizational concept based on Associations, each having an official ESC scientific journal and an annual ESC connected congress. The European Association for Cardiovascular Prevention and Rehabilitation was built on the fundaments of epidemiology and prevention, exercise physiology, cardiac rehabilitation and sports cardiology. The official journal of the Association was launched in 2003 and the first EuroPRevent Congress was held in Athens in 2006. During the following years, the different interests of the founding working groups came closer together, which resulted in a name change of the Association into "European Association of Preventive Cardiology" and of the journal into "European Journal of Preventive Cardiology". The name change marked the migration of Preventive Cardiology to centre stage in the ESC. This document summarizes how and from where the EAPC started and where it stands now. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: [email protected]
Peer Networking and Community Change: Improving Foundation Practice
No full text· This article brings together the Annie E. Casey Foundation’s 15 years of experience with peer networking— examining through two research studies the process of peer networking and its impact, both with community-based and funder groups.
· Peer networking helps people with common interests to exchange information, disseminate good practices, and build a leadership structure for work they do together, such as a community change initiative.
· Casey’s research identified 10 good practices for effective peer networking, as well as 10 challenges that can affect its success; a four-level model was created to provide context for these findings.
· The research indicates that peer networking can have significant impact for communities and in meeting philanthropic goals, but it is costly and must be carefully structured if it is to be successful.
· Casey is working to synthesize its peer networking practices into a more strategic framework, and other foundations might use some of its lessons learned to enhance their own practices in this area
Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine.
No full textOBJECTIVE: Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock.
METHODS: The European Society of Intensive Care Medicine invited 12 experts to form a Task Force to update a previous consensus (Antonelli et al.: Intensive Care Med 33:575-590, 2007). The same five questions addressed in the earlier consensus were used as the outline for the literature search and review, with the aim of the Task Force to produce statements based on the available literature and evidence. These questions were: (1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit ? (2) Should we monitor preload and fluid responsiveness in shock ? (3) How and when should we monitor stroke volume or cardiac output in shock ? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock ? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock ? Four types of statements were used: definition, recommendation, best practice and statement of fact.
RESULTS: Forty-four statements were made. The main new statements include: (1) statements on individualizing blood pressure targets; (2) statements on the assessment and prediction of fluid responsiveness; (3) statements on the use of echocardiography and hemodynamic monitoring.
CONCLUSIONS: This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock
Prevalência de osteoartrite de joelho na população acima de 50anos usuária da unidade local de saúde saúde Saco Grande.
No full textTrabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Departamento de Saúde Pública
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