Abstract:
OBJECTIVE:Inotropic and vasopressor drugs are routinely used in critically ill patients to maintain adequate blood pressure and cardiac output in patients with cardiogenic shock although potentially at the expense of increasing myocardial oxygen demand. Pacing optimization has been demonstrated as effective in reducing catecholamine requirements in patients with chronic heart failure by improving cardiac efficiency; however, there are no reports relating to the effectiveness of pacemaker optimization on cardiac output in critically ill patients with cardiogenic shock in the intensive care. DATA SOURCES:Retrospective data analysis. STUDY SELECTION:Twenty-bed adult tertiary cardiothoracic ICU, university hospital. DATA EXTRACTION:Eight sequential patients receiving dual chamber pacemaker with DDD modality with cardiogenic shock and hemodynamic instability refractory to catecholamines underwent echocardiography-guided pacemaker optimization of cardiac output. An iterative method with Doppler echocardiography was used to assess changes in cardiac output, left ventricular filling time, ejection time, total isovolumic time, mitral regurgitation, ejection fraction, and blood pressure at different increments of heart rate, and atrioventricular and interventricular delay. All results are shown as median (minimum/maximum level) or mean ± SD. DATA SYNTHESIS:Using echocardiography-guided pacemaker optimization on cardiac output, the cardiac output increased from 3.2 (2.3/3.8) to 5.7 L/min (4.85/7.1) and cardiac index from 1.64 (1.1/1.9) to 2.68 L/min/m (2.1/3.2) and the total isovolumic time reduced from 22.8 to normal values (<14). In association, the glomerular filtration rate increased significantly except in one patient with stage IV chronic kidney disease. All inotropes and vasopressors were discontinued within 12 hours of pacemaker optimization on cardiac output, and all patients were discharged from the ICU within 1 week. CONCLUSIONS:Echocardiography-guided pacemaker optimization of cardiac output is a feasible bedside therapeutic option, which should be considered when standard medical treatments are insufficient for the treatment of cardiogenic shock refractory to inotropic support, thereby minimizing the detrimental effect of catecholamines.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Tavazzi G,Kontogeorgis A,Bergsland NP,Price Sdoi
10.1097/CCM.0000000000001655subject
Has Abstractpub_date
2016-08-01 00:00:00pages
e755-61issue
8eissn
0090-3493issn
1530-0293journal_volume
44pub_type
杂志文章abstract:OBJECTIVES:To evaluate the use of multifrequency bioelectrical impedance analysis to predict creatinine/urea clearance based on 24 hours urine collection. A practical formula was developed, and its performance was compared with that of established formulas such as Cockcroft-Gault, Modification of Diet in Renal Disease,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004033
更新日期:2019-12-01 00:00:00
abstract::Critically ill patients who fear impending death may die suddenly. We studied prospectively the incidence of death in critically ill surgical patients who articulated the fear that they were about to die. Physiologic, environmental, and behavioral correlates which might influence perceptions of impending death were ex...
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abstract:OBJECTIVE:Sepsis is associated with a marked depression of cellular immune function. The steroid hormone dehydroepiandrosterone (DHEA) is proposed to have immunoenhancing activities. We, therefore, investigated the effect of DHEA on the mortality rate and cellular immune functions in an experimental model of sepsis. D...
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doi:10.1097/00003246-200102000-00029
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abstract:OBJECTIVE:Pulmonary edema is a serious condition following brain injury of diverse etiologies, including large hemispheric infarctions. We have previously shown that treatment with hypertonic saline attenuates cerebral edema associated with experimental ischemic stroke. In a well-characterized animal model of large isc...
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doi:10.1097/01.ccm.0000150659.15558.23
更新日期:2005-01-01 00:00:00
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doi:10.1097/CCM.0000000000004377
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journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1998-07-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1097/CCM.0b013e31821201a5
更新日期:2011-07-01 00:00:00
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更新日期:2009-01-01 00:00:00
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更新日期:1984-12-01 00:00:00
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更新日期:2001-03-01 00:00:00
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doi:10.1097/CCM.0000000000003620
更新日期:2019-03-01 00:00:00
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更新日期:2002-12-01 00:00:00
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更新日期:2000-06-01 00:00:00
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更新日期:2003-12-01 00:00:00
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更新日期:2000-04-01 00:00:00
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pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:2003-03-01 00:00:00
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pub_type: 指南,杂志文章,实务指引,评审
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更新日期:2015-02-01 00:00:00
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更新日期:1995-02-01 00:00:00
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doi:10.1097/00003246-198502000-00009
更新日期:1985-02-01 00:00:00
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doi:10.1097/00003246-200107001-00028
更新日期:2001-07-01 00:00:00
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更新日期:2016-03-01 00:00:00
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doi:10.1097/CCM.0b013e31818f2269
更新日期:2008-12-01 00:00:00
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更新日期:2002-11-01 00:00:00
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更新日期:1984-01-01 00:00:00
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更新日期:1983-06-01 00:00:00
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更新日期:2001-10-01 00:00:00