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
R&D subsidies and foreign ownership: Carrying Flemish coals to Newcastle?.
No full textR&D subsidies; R&D expenditure; innovative performance; economic value creation; foreign ownership; multinational; policy evaluation; semi-parametric matching;
Traité de l'attaque et de la défense des places : avec des remarques sur la fortification, et la manière de surprendre une place
No full textpar D. BourdetAuf Frontispiz: chez la veuve de Paul Marret, 172
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]
Can changes in arterial pressure be used to detect changes in cardiac index during fluid challenge in patients with septic shock?
No full textResponse to fluid challenge is often defined as an increase in cardiac index (CI) of more than 10-15%. However, in clinical practice CI values are often not available. We evaluated whether changes in mean arterial pressure (MAP) correlate with changes in CI after fluid challenge in patients with septic shock.
METHODS:
This was an observational study in which we reviewed prospectively collected data from 51 septic shock patients in whom complete hemodynamic measurements had been obtained before and after a fluid challenge with 1,000 ml crystalloid (Hartman's solution) or 500 ml colloid (hydroxyethyl starch 6%). CI was measured using thermodilution. Patients were divided into two groups (responders and non-responders) according to their change in CI (responders: %CI >10%) after the fluid challenge. Statistical analysis was performed using a two-way analysis of variance test followed by a Student's t test with adjustment for multiple comparisons. Pearson's correlation and receiver operating characteristic curve analysis were also used.
RESULTS:
Mean patient age was 67 ± 17 years and mean Sequential Organ Failure Assessment (SOFA) upon admittance to the intensive care unit was 10 ± 3. In the 25 responders, MAP increased from 69 ± 9 to 77 ± 9 mmHg, pulse pressure (PP) increased from 59 ± 15 to 67 ± 16, and CI increased from 2.8 ± 0.8 to 3.4 ± 0.9 L/min/m(2) (all p < 0.001). There were no significant correlations between the changes in MAP, PP, and CI.
CONCLUSIONS:
Changes in MAP do not reliably track changes in CI after fluid challenge in patients with septic shock and, consequently, should be interpreted carefully when evaluating the response to fluid challenge in such patients
- …
