Broad spectrum vasopressors: a new approach to the initial management of septic shock?

The mainstay of hemodynamic treatment of septic shock is fluid resuscitation followed by vasopressors where fluids alone are insufficient to achieve target blood pressure. Norepinephrine, a catecholamine, is t...
Source: Critical Care - Category: Intensive Care Authors: Tags: Commentary Source Type: research

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In Reply We agree with Dr Rehberg and colleagues that our study demonstrated that selepressin had a number of advantageous physiologic effects on blood pressure, urine output, and other features associated with septic shock. In this way, as the authors suggest, it appears that selepressin shares a set of properties similar to that of other agents used for cardiovascular support in septic shock, including the recently approved angiotensin II. In contrast to the study on which angiotensin II was approved, we chose a primary outcome designed to determine whether care with selepressin improved downstream patient-centered outco...
Source: JAMA - Category: General Medicine Source Type: research
To the Editor Compared with placebo, the nonadrenergic vasopressor angiotensin II was shown to increase mean arterial pressure after 3 hours in patients with vasodilatory shock in the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) trial (primary end point). In addition, angiotensin II also reached the secondary goal of a greater reduction in the cardiovascular Sequential Organ Failure Assessment (SOFA) score after 48 hours vs placebo. As a consequence, research with angiotensin II continued and it was approved by the US Food and Drug Administration.
Source: JAMA - Category: General Medicine Source Type: research
Mabrouk Bahloul, Sabrine Bradai, Olfa Turki, Karama Bouchaala, Nadia Khlaf Bouaziz, Hedi Chelly, Sondes Haddar, Mounir BouazizJournal of Anaesthesiology Clinical Pharmacology 2020 36(1):135-137
Source: Journal of Anaesthesiology Clinical Pharmacology - Category: Anesthesiology Authors: Source Type: research
We describe the clinical outcomes of adults who received ECMO in septic shock.MethodsWe retrospectively studied adults supported on veno-arterial or veno-venous modes of ECMO with septic shock at the time of cannulation from 1/1/2009-12/31/2016 at a quaternary medical center in the United States. The primary outcome was rate of survival to hospital discharge and time to survival using Kaplan-Meier survival estimates. We analyzed survival by mode, previous cardiac arrest and timing of cannulation (
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
As patient data are increasingly captured digitally, the opportunities to deploy artificial intelligence (AI), especially machine learning, are increasing rapidly. Machine learning is automated learning by computers using tools such as artificial neural networks to search data iteratively for optimal solutions. Typical applications include searching for novel patterns (eg, latent cancer subtypes), making a diagnosis or outcome prediction (eg, diabetic retinopathy), and optimizing treatment decisions (eg, fluid and vasopressor titration for septic shock). Although many express excitement regarding the promise of AI, others ...
Source: JAMA - Journal of the American Medical Association - Category: General Medicine Source Type: research
Authors: Fernández Conesa M, Milena Muñoz A, Valero González MÁ Abstract We read with interest the article by Guido Villa-Gómez, Manuel Alejandro Mahler and Dante Manazzoni "A new case of pseudoaneurysm of the right hepatic artery secondary to laparoscopic cholecystectomy". A 57-year-old cholecystectomized female was admitted due to abdominal pain with an analytical pattern of cholestasis and liver enzyme alterations, with cholangitis that progressed to septic shock of a biliary origin with gradual anemia and hypotension. PMID: 32054281 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
Conclusions: Current randomized evidence showed that continuous IV administration of epinephrine as inotropic/vasopressor agent is not associated with a worse outcome in critically ill patients.
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Review Articles Source Type: research
No abstract available
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Editorials Source Type: research
Conclusions: Sepsis affects a fifth of patients admitted to ICUs in mainland China with a 90-day mortality rate of 35.5%. Our findings indicate that a large burden of sepsis, and we need to focus on sepsis as a quality improvement target in China given the high mortality. In addition, further studies are needed to delineate the epidemiology of sepsis outside the ICU.
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research
No abstract available
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research
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