-
Burns : Journal of the International... Feb 2021Vasopressors may be required during acute burn resuscitation to support mean arterial blood pressure, but their use is not well-described in the burn literature. The... (Review)
Review
BACKGROUND
Vasopressors may be required during acute burn resuscitation to support mean arterial blood pressure, but their use is not well-described in the burn literature. The purpose of this study was to examine vasopressor use during acute fluid resuscitation.
METHODS
Retrospective review of adults with burns ≥ 20% TBSA admitted to an ABA-verified regional burn center. Patients administered an infusion of a vasopressor for at least 30 min during the 1 st 48 h post-burn formed the PRESSOR group while patients who did not receive vasopressors formed the NoPRESSOR group.
RESULTS
We studied 52 burned adults, 85% of which had flame burns. Vasopressors were administered during resuscitation to 31% of patients. Vasopressor infusions began at 20.9 ± 10.9 h post burn and were continued for 16.8 ± 10.8 h. PRESSOR patients (N = 16) had significantly greater total (p = 0.001) and full thickness burn size (p < 0.001), and need for mechanical ventilation (p = 0.005) than NoPRESSOR patients (N = 36). PRESSOR and NoPRESSOR patients did not differ significantly in per cent predicted fluid volume received in the first 24 h (143 ± 58 Vs. 125 ± 46 respectively). PRESSOR patients compared to NoPRESSOR patients tended to have been administered 5% albumin (Alb) less often (38% Vs 47%) and high dose vitamin C (HDVC) more often during resuscitation (69% vs 17%). Multivariate regression analysis found that patient age (OR 1.189, 95% CI: 1.047, 1.351) and HDVC (OR 24.701, 95% CI: 1.558, 391.551) were independently associated with greater use of vasopressors. An inverse probability weighted propensity analysis also identified a significant association between HDVC and increased use of vasopressors (OR 6.902, 95 % CI: 2.503, 19.026), and significantly decreased vasopressor administration following Alb administration (OR 0.310, 95% CI: 0.130, 0.739).
CONCLUSION
Advanced age appears to be the most important determinant of vasopressor use during resuscitation. While vasopressor requirements appear to have been increased by HDVC and decreased by Alb, this needs to be formally evaluated in a large randomized study.
Topics: Adult; Aged; Burns; Chi-Square Distribution; Female; Fluid Therapy; Humans; Male; Middle Aged; Resuscitation; Retrospective Studies; Vasoconstrictor Agents
PubMed: 33293152
DOI: 10.1016/j.burns.2020.09.005 -
Anesthesiology Feb 2022
Topics: Fluid Therapy; Vasoconstrictor Agents
PubMed: 34816279
DOI: 10.1097/ALN.0000000000004062 -
Anesthesiology Feb 2022
Topics: Fluid Therapy; Vasoconstrictor Agents
PubMed: 34816275
DOI: 10.1097/ALN.0000000000004063 -
Alimentary Pharmacology & Therapeutics Sep 2020
Topics: Hepatorenal Syndrome; Humans; Lypressin; Terlipressin; Vasoconstrictor Agents
PubMed: 32852817
DOI: 10.1111/apt.15943 -
Pregnancy Hypertension Jun 2022The activation of the Renin Angiotensin System (RAS) is required during pregnancy and it seems that RAS dysfunction has some important effects on pathological pregnancy... (Review)
Review
The activation of the Renin Angiotensin System (RAS) is required during pregnancy and it seems that RAS dysfunction has some important effects on pathological pregnancy conditions, including preeclampsia (PE). The objective of this review is to summarize and to discuss the role of the RAS in normal pregnancy and in PE. We found evidence that the RAS is important for the evolution of pregnancy under physiological conditions and plays an important role in the pathogenesis of PE. In normal gestation, almost all circulating components of RAS are increased and there is a general state of non-reactivity to the vasoconstrictor actions of Angiotensin (Ang) II. In PE, changes in the circulating levels of RAS components occur, especially with an intense decrease in the levels of Ang I, Ang II and Ang-(1-7). Our findings endorse the idea that PE is a disease whose cornerstone relies on altered placental physiology. There are high tissue levels of Ang II type 1 receptor (AT1R) in the musculature of the blood vessels and in the placenta, generating a state of increased sensitivity to the vasoconstrictor action of Ang II. AT1R autoantibodies (AT1R-AA) might be one of the key points for the vicious cycle of PE, as these molecules are synthesized in situations of hypoxia and enhance placental vasoconstriction, causing even more hypoxia. Further studies are needed to investigate the role of circulating RAS, uteroplacental RAS and local RAS molecules from other tissues related to the pathogenesis of PE.
Topics: Angiotensin II; Female; Humans; Hypoxia; Placenta; Pre-Eclampsia; Pregnancy; Renin-Angiotensin System; Vasoconstrictor Agents
PubMed: 35149272
DOI: 10.1016/j.preghy.2022.01.011 -
The Medical Letter on Drugs and... Mar 2023
Topics: Humans; Terlipressin; Hepatorenal Syndrome; Vasoconstrictor Agents; Octreotide; Treatment Outcome
PubMed: 36897603
DOI: 10.58347/tml.2023.1672c -
Microsurgery Jul 2023Blood pressure regulation is critical in patients undergoing microsurgical free tissue transfer; however, guidelines for addressing and preventing perioperative... (Review)
Review
Blood pressure regulation is critical in patients undergoing microsurgical free tissue transfer; however, guidelines for addressing and preventing perioperative hypotension remain highly debated, with two current thought paradigms: (1) intravenous fluid administration with a balanced salt solution (e.g., lactate ringer and normal saline) and/or colloid (e.g., albumin) and (2) vasoactive pharmacological support with vasopressors (e.g., dobutamine, norepinephrine, epinephrine), with fluid administration being the preferred conventional approach. Here, we review the most up to date available literature and summarize currents perspectives and practices for fluid resuscitation and vasopressor use, while offering evidence-based guidelines to each.
Topics: Humans; Microsurgery; Vasoconstrictor Agents; Epinephrine; Norepinephrine; Fluid Therapy
PubMed: 37052570
DOI: 10.1002/micr.31047 -
Headache Sep 2021
Topics: Adult; Calcitonin Gene-Related Peptide Receptor Antagonists; Dihydroergotamine; Humans; Migraine Disorders; Piperidines; Pyridines; Vasoconstrictor Agents
PubMed: 34350590
DOI: 10.1111/head.14181 -
Current Heart Failure Reports Dec 2020Worldwide, cardiogenic shock (CS) is the leading cause of death in patients admitted with an acute myocardial infarction (AMI). CS is characterised by reduced cardiac... (Review)
Review
BACKGROUND
Worldwide, cardiogenic shock (CS) is the leading cause of death in patients admitted with an acute myocardial infarction (AMI). CS is characterised by reduced cardiac output secondary to systolic dysfunction which can lead to multi-organ failure. The mainstay of medical treatment in CS are inotropes and vasopressors to improve cardiac output. However, current clinical guidelines do not direct clinicians as to which agents to use and in what combinations. This article aims to review the current evidence on the management of CS with a major focus on the use of inotropes and vasopressors.
METHOD
A literature review was conducted analysing published literature from the following databases: PubMed, MedLine, Cochrane Library and Embase, as well as a manual search of articles that were deemed relevant. Relevant articles were identified by using keywords such as "cardiogenic shock".
RESULTS
Literature was assessed to review the use of inotropes and vasopressors in CS. Dopamine and adrenaline were associated with increased mortality and arrhythmias. Dobutamine was associated with an improvement in cardiac output, at the determinant of causing arrhythmias. Conversely, noradrenaline was associated with a lower likelihood of arrhythmias and most importantly decreased mortality in CS. Compared to other inotropes, levosimendan appears to have a better safety profile and is associated with decreased mortality in CS, particularly when combined with a vasopressor. Our literature review suggests that treatment combination of the inotrope levosimendan with the vasopressor noradrenaline may be the most effective management option in CS.
Topics: Cardiotonic Agents; Humans; Shock, Cardiogenic; Vasoconstrictor Agents
PubMed: 33103204
DOI: 10.1007/s11897-020-00493-9 -
Critical Care Medicine Dec 2023To determine if angiotensin II is associated with improved outcomes as measured by 30- and 90-day mortality as well as other secondary outcomes such as organ dysfunction...
OBJECTIVES
To determine if angiotensin II is associated with improved outcomes as measured by 30- and 90-day mortality as well as other secondary outcomes such as organ dysfunction and adverse events.
DESIGN
Retrospective, matched analysis of patients receiving angiotensin II compared with both historical and concurrent controls receiving equivalent doses of nonangiotensin II vasopressors.
SETTING
Multiple ICUs in a large, university-based hospital.
PATIENTS
Eight hundred thirteen adult patients with shock admitted to an ICU and requiring vasopressor support.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Angiotensin II use had no association with the primary outcome of 30-day mortality (60% vs 56%; p = 0.292). The secondary outcome of 90-day mortality was also similar (65% vs 63%; p = 0.440) as were changes in Sequential Organ Failure Assessment scores over a 5-day monitoring period after enrollment. Angiotensin II was not associated with increased rates of kidney replacement therapy (odds ratio [OR], 1.39; 95% CI, 0.88-2.19; p = 0.158) or receipt of mechanical ventilation (OR, 1.50; 95% CI, 0.41-5.51; p = 0.539) after enrollment, and the rate of thrombotic events was similar between angiotensin II and control patients (OR, 1.02; 95% CI, 0.71-1.48; p = 0.912).
CONCLUSIONS
In patients with severe shock, angiotensin II was not associated with improved mortality or organ dysfunction and was not associated with an increased rate of adverse events.
Topics: Adult; Humans; Angiotensin II; Multiple Organ Failure; Retrospective Studies; Shock; Vasoconstrictor Agents
PubMed: 37378469
DOI: 10.1097/CCM.0000000000005975