Abstract：
:Patients admitted to the cardiac intensive care unit (CICU) are often in shock and require hemodynamic support. Identifying and addressing the pathophysiology mechanisms operating in an individual patient is crucial to achieving a successful outcome, while initiating circulatory support therapy to restore adequate tissue perfusion. Vasopressors and inotropes are the cornerstone of supportive medical therapy for shock, in addition to fluid resuscitation when indicated. Timely initiation of optimal vasopressor and inotrope therapy is essential for patients with shock, with the ultimate goals of restoring effective tissue perfusion in order to normalize cellular metabolism. Use of vasoactive agents for hemodynamic support of patients with shock should take both arterial pressure and tissue perfusion into account when choosing therapeutic interventions. For most patients with shock, including cardiogenic or septic shock, norepinephrine (NE) is an appropriate choice as a first-line vasopressor titrated to achieve an adequate arterial pressure due to a lower risk of adverse events than other catecholamine vasopressors. If tissue and organ perfusion remain inadequate, an inotrope such as dobutamine may be added to increase cardiac output to a sufficient level that meets tissue demand. Low doses of epinephrine or dopamine may be used for inotropic support, but high doses of these drugs carry an excessive risk of adverse events when used for vasopressor support and should be avoided. When NE alone is inadequate to achieve an adequate arterial pressure, addition of a noncatecholamine vasopressor such as vasopressin or angiotensin-II is reasonable, in addition to rescue therapies that may improve vasopressor responsiveness. In this review, we discuss the pharmacology and evidence-based use of vasopressor and inotrope drugs in critically ill patients, with a focus on the CICU population.
journal_name
J Intensive Care Medjournal_title
Journal of intensive care medicineauthors
Jentzer JC,Hollenberg SMdoi
10.1177/0885066620917630subject
Has Abstractpub_date
2020-04-13 00:00:00pages
885066620917630eissn
0885-0666issn
1525-1489pub_type
杂志文章abstract：:Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous develop...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066613485215
更新日期：2014-11-01 00:00:00
abstract：:Hyponatremia is one of the newer and emerging risk factors for an adverse prognosis in chronic heart failure. Why decreased serum sodium is associated with worse prognosis remains unclear. It may reflect worsening heart failure and the deleterious effects of activation of neurohormones. The mechanism of hyponatremia i...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066609344941
更新日期：2009-11-01 00:00:00
abstract：OBJECTIVE:To evaluate the effect of high-flow nasal cannula oxygen (HFNO) therapy on hospital length of stay (LOS) and postoperative pulmonary complications (PPCs) in adult postoperative patients. DATA SOURCES:PubMed, Embase, the Cochrane Library, Web of Science of Studies, China National Knowledge Index, and Wan Fang...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066618817718
更新日期：2020-10-01 00:00:00
abstract：PURPOSE:The strategy used to improve effective checklist use in intensive care unit (ICU) setting is essential for checklist success. This study aimed to test the hypothesis that an electronic checklist could reduce ICU provider workload, errors, and time to checklist completion, as compared to a paper checklist. METH...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066614558015
更新日期：2016-03-01 00:00:00
abstract：BACKGROUND::The diagnosis of sepsis is challenging in the absence of a gold standard test. Recent studies have explored the role of neutrophil and monocyte volume, conductivity, and scatter (VCS), derived from automated hematology analyzers, in diagnosing sepsis. We assessed the diagnostic accuracy of VCS parameters in...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066616682940
更新日期：2018-12-01 00:00:00
abstract：:The authors retrospectively review their experience with low immunoglobulin G (IgG) levels in a pediatric ICU population over a 12-month period. The total IgG level was below the normal for age in 14 of the 20 patients. The 14 patients with a low IgG level were younger and weighed less when compared with the 6 patient...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066603255905
更新日期：2003-09-01 00:00:00
abstract：RATIONALE:The feasibility and clinical outcomes of conservative fluid management after sepsis resuscitation remain unknown. OBJECTIVES:To evaluate the effect of a conservative fluid management protocol on fluid balance and intensive care unit (ICU)-free days among patients with sepsis. METHODS:In a single-center phas...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066618823183
更新日期：2020-12-01 00:00:00
abstract：BACKGROUND:Insulin receptors (IRs) in the brain have unique molecular features and a characteristic pattern of distribution. Their possible functions extend beyond glucose utilization. In this systematic review, we explore the interactions between insulin and the brain and its implications for anesthesiologists, critic...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066615594341
更新日期：2017-01-01 00:00:00
abstract：BACKGROUND:Among respiratory predictors, rapid shallow breathing index (RSBI) has been a commonly used respiratory parameter to predict extubation outcomes. However, the outcome of prediction remains inconsistent. Regarding nonrespiratory predictors, serum albumin, hemoglobin, bicarbonate, and patients' alertness have ...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066617706688
更新日期：2019-08-01 00:00:00
abstract：:Substantial progress has been made to create innovative technology that can monitor the different physiological characteristics that precede the onset of secondary brain injury, with the ultimate goal of intervening prior to the onset of irreversible neurological damage. One of the goals of neurocritical care is to re...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066618788022
更新日期：2019-06-01 00:00:00
abstract：:The rapid spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to a global pandemic. The 2019 coronavirus disease (COVID-19) presents with a spectrum of symptoms ranging from mild to critical illness requiring intensive care unit (ICU) admission. Acute respiratory distress syndrome is a m...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066620951426
更新日期：2021-02-01 00:00:00
abstract：:Vasopressin has gained wide support as an adjunct vasopressor in patients with septic shock. This agent exerts its vasoconstriction effects through smooth muscle V1 receptors and also has antidiuretic activity via renal V2 receptors. This interaction with the renal V2 receptors results in the integration of aquaporin ...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066613507410
更新日期：2015-07-01 00:00:00
abstract：BACKGROUND:Admission to an intensive care unit (ICU) specialized for brain and spine injury patients is associated with improved outcome. We investigated the effects of the first dedicated, combined neurological and neurosurgical ICU (NeuroICU) in Korea on patient outcomes. METHODS:The first dedicated NeuroICU in Kore...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066617706675
更新日期：2019-02-01 00:00:00
abstract：:We report the success rate and complications of peripherally inserted central catheters (PICCs) in patients hospitalized in an intensive care unit (ICU). We performed a cohort study in the ICU of a large tertiary care, university-affiliated community hospital. All ICU patients for whom their attending physicians reque...
journal_title：Journal of intensive care medicine
pub_type： 临床试验,杂志文章
doi：10.1177/088506669601100107
更新日期：1996-01-01 00:00:00
abstract：:Echodynamics refers to the use of echocardiography as hemodynamic tool mostly in intensive and acute care settings. It implies a smooth drift from the classic cardiology use to a more critical care adjusted use. A more personalized approach is advocated in critical care, and echo is one way to reach such goal. Correct...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066617734151
更新日期：2018-08-01 00:00:00
abstract：BACKGROUND:In the setting of the COVID pandemic, many patients falling ill with acute respiratory distress syndrome eventually require prone positioning for gas exchange. Traditionally, central venous catheters are inserted with patient in the supine or Trendelenburg position. However, when a patient cannot tolerate su...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066620959649
更新日期：2020-09-16 00:00:00
abstract：:Controlled donation after circulatory determination of death (cDCDD) concerns donation after withdrawal of life-sustaining therapy (W-LST). We examine the ethical issues raised by W-LST in the cDCDD context in the light of a review of cDCDD protocols and the ethical literature. Our analysis confirms that W-LST procedu...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066615625628
更新日期：2017-03-01 00:00:00
abstract：INTRODUCTION:Red cell distribution width (RDW) is reflective of systemic inflammation. The objective of this study was to investigate the association between RDW (on day 1 of development of septic shock) and mortality. METHODS:A total of 279 patients with septic shock were included. We categorized the patients into qu...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066612452838
更新日期：2013-09-01 00:00:00
abstract：:Cirrhotic patients admitted to the medical intensive care unit (ICU) are associated with high mortality rates. The prognosis of critically ill cirrhotic patients is determined by the extent of hepatic and extrahepatic organ dysfunction. This study was conducted to assess and compare the accuracy of the Child-Pugh clas...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066603261991
更新日期：2004-03-01 00:00:00
abstract：:The brain reacts to injury or disease by cascades of cellular and molecular responses. Evidence suggests that immune-inflammatory processes are key elements in the physiopathological processes associated with brain injury or damage. Cytokines are among major mediators implicated in these processes. Cytokine responses ...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066608318458
更新日期：2008-07-01 00:00:00
abstract：PURPOSE:Conflicting results exist regarding the efficacy of N-acetyl cysteine (NAC) in sepsis treatment. A pivotal factor affecting the therapeutic potency of NAC in sepsis is timing and dosing of its infusion. We aimed to assess the effect of NAC on redox status of patients with sepsis and to compare its efficacy in i...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066618823152
更新日期：2020-12-01 00:00:00
abstract：:Hypercalcemia may be seen in a variety of clinical settings and often requires intensive management when serum calcium levels are dramatically elevated. All of the many etiologies of mild hypercalcemia can lead to severe hypercalcemia. Knowledge of the physiologic mechanisms involved in maintaining normocalcemia and b...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066613507530
更新日期：2015-07-01 00:00:00
abstract：:Objectives: Standard management strategies for lowering intracranial pressure (ICP) in traumatic brain injury has been well-studied, but the use of lesser known interventions for ICP in subarachnoid hemorrhage (SAH) remains elusive. Searches were performed in PubMed and EBSCO Host to identify best available evidence f...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066618813073
更新日期：2020-03-01 00:00:00
abstract：:Patients undergoing surgery for pituitary tumors represent a heterogeneous population each with unique clinical, biochemical, radiologic, pathologic, neurologic, and/or ophthalmologic considerations. The postoperative management of patients following pituitary surgery often occurs in the context of a dynamic state of ...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066605275247
更新日期：2005-05-01 00:00:00
abstract：:The objective of this retrospective study was to determine the optimal initial antibiotic regimen for hospital-acquired pneumonia using the frequency and sensitivity of Gram negative microorganisms found in sputum cultures. An antibiogram was constructed and compared with the hospital intensive care unit (ICU) antibio...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066605278650
更新日期：2005-09-01 00:00:00
abstract：OBJECTIVE:To describe intubation practices and duration of mechanical ventilation in children with status asthmaticus admitted from emergency departments (ERs) to pediatric intensive care units (PICUs). DESIGN:Retrospective cohort study using the Virtual PICU Performance System database (VPS, LLC) of children with sta...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066613476446
更新日期：2014-05-01 00:00:00
abstract：:The treatment of sepsis is an ongoing challenge for clinicians; despite the wide choice of effective antibiotics to treat infection, sepsis remains the leading cause of morbidity and mortality for patients admitted to an intensive care unit. Dysregulation of the immune response is now recognized to be a key factor in ...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066611425759
更新日期：2013-09-01 00:00:00
abstract：:Cardiac transplantation has now become accepted therapy for the treatment of end-stage heart disease in both children and adults, and literally thousands of patients are bearers of cardiac grafts. Because of these patients' susceptibility to infections, rejection, coronary disease, and malignancy, as well as to serio...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/088506669100600201
更新日期：1991-03-01 00:00:00
abstract：:Thyroid storm, an endocrine emergency first described in 1926, remains a diagnostic and therapeutic challenge. No laboratory abnormalities are specific to thyroid storm, and the available scoring system is based on the clinical criteria. The exact mechanisms underlying the development of thyroid storm from uncomplicat...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章,评审
doi：10.1177/0885066613498053
更新日期：2015-03-01 00:00:00
abstract：:Primary and acquired abdominal pathology accounts for a significant proportion of sepsis and SIRS in the ICU population. Abdominal processes often present a difficult diagnostic dilemma in the truly critically ill patient who, due to hemodynamic instability or severe acute respiratory distress syndrome (ARDS) requirin...
journal_title：Journal of intensive care medicine
pub_type： 杂志文章
doi：10.1177/0885066613492102
更新日期：2015-07-01 00:00:00
