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Archives of Surgery (Chicago, Ill. :... Aug 1964
REGIONAL BLOOD FLOW ALTERATIONS. STUDIES OF CHANGES IN THIS COURSE PRODUCED BY A VASOCONSTRICTOR AND AN ADRENERGIC BLOCKING AGENT DURING READJUSTMENT TO HEMORRHAGIC SHOCK.
Topics: Adrenergic Antagonists; Animals; Blood Circulation; Blood Flow Velocity; Blood Pressure; Dogs; Norepinephrine; Pharmacology; Phenoxybenzamine; Physiology; Regional Blood Flow; Research; Shock; Shock, Hemorrhagic; Vasoconstrictor Agents
PubMed: 14160163
DOI: 10.1001/archsurg.1964.01320020108017 -
European Radiology May 2023To evaluate the influence of vasoconstrictor agents (VCAs) on signs of vasoconstriction and bowel ischemia on MDCT detected in patients with non-occlusive mesenteric...
OBJECTIVES
To evaluate the influence of vasoconstrictor agents (VCAs) on signs of vasoconstriction and bowel ischemia on MDCT detected in patients with non-occlusive mesenteric ischemia (NOMI).
METHODS
This 8-year single-center retrospective study consecutively included all patients with histopathologically proven NOMI who underwent MDCT ≤ 48 h prior to surgical bowel resection. Two blinded radiologists jointly reviewed each examination for signs of bowel ischemia, abdominal organ infarct, mesenteric vessel size and regularity, and ancillary vascular findings. VCA administration (length and dosage), clinical and biochemical data, risk factors, and outcomes were retrieved from patients' medical records. Subgroup comparisons were performed.
RESULTS
Ninety patients were included (59 males, mean age 65 years); 40 (44.4%) had received VCAs before MDCT. Overall mortality was 32% (n = 29), with no significant difference between the two groups. In patients treated with VCAs, the calibre of the superior mesenteric artery (SMA) was smaller (p = 0.032), and vasoconstriction of its branches tended to be more important (p = 0.096) than in patients not treated with VCAs. The presence and extent of bowel ischemia did not significantly correlate with VCA administration, but abdominal organ infarcts tended to be more frequent (p = 0.005) and involved more organs (p = 0.088). The VCA group had lower mean arterial pressure (p = 0.006) and lower hemoglobin levels (p < 0.001). Several biomarkers of organ failure and inflammation, differed significantly with VCA use, proving worse clinical condition.
CONCLUSIONS
MDCT demonstrates more severe SMA vasoconstriction and tends to show increased abdominal organ infarcts after VCA administration in NOMI patients compared to NOMI patients not treated with VCAs.
KEY POINTS
• In critically ill patients with NOMI, MDCT demonstrates VCA support via increased vasoconstriction of the main SMA and its branches. • VCA administration in NOMI patients tends to contribute to the development of organ infarcts, as shown on MDCT. • An important degree of vasoconstriction in NOMI patients may indicate insufficient resuscitation and, thus, help clinicians in further patient management.
Topics: Male; Humans; Aged; Mesenteric Ischemia; Retrospective Studies; Vasoconstrictor Agents; Tomography, X-Ray Computed; Ischemia; Infarction
PubMed: 36692594
DOI: 10.1007/s00330-023-09415-4 -
Anaesthesia Jan 2024We conducted a systematic review of the literature reporting phenylephrine-induced changes in blood pressure, cardiac output, cerebral blood flow and cerebral tissue... (Review)
Review
We conducted a systematic review of the literature reporting phenylephrine-induced changes in blood pressure, cardiac output, cerebral blood flow and cerebral tissue oxygen saturation as measured by near-infrared spectroscopy in humans. We used the proportion change of the group mean values reported by the original studies in our analysis. Phenylephrine elevates blood pressure whilst concurrently inducing a reduction in cardiac output. Furthermore, despite increasing cerebral blood flow, it decreases cerebral tissue oxygen saturation. The extent of phenylephrine's influence on cardiac output (r = -0.54 and p = 0.09 in awake humans; r = -0.55 and p = 0.007 in anaesthetised humans), cerebral blood flow (r = 0.65 and p = 0.002 in awake humans; r = 0.80 and p = 0.003 in anaesthetised humans) and cerebral tissue oxygen saturation (r = -0.72 and p = 0.03 in awake humans; r = -0.24 and p = 0.48 in anaesthetised humans) appears closely linked to the magnitude of phenylephrine-induced blood pressure changes. When comparing the effects of phenylephrine in awake and anaesthetised humans, we found no evidence of a significant difference in cardiac output, cerebral blood flow or cerebral tissue oxygen saturation. There was also no evidence of a significant difference in effect on systemic and cerebral circulations whether phenylephrine was given by bolus or infusion. We explore the underlying mechanisms driving the phenylephrine-induced cardiac output reduction, cerebral blood flow increase and cerebral tissue oxygen saturation decrease. Individualised treatment approaches, close monitoring and consideration of potential risks and benefits remain vital to the safe and effective use of phenylephrine in acute care.
Topics: Humans; Phenylephrine; Vasoconstrictor Agents; Oxygen; Blood Pressure; Cerebrovascular Circulation
PubMed: 37948131
DOI: 10.1111/anae.16172 -
Intensive Care Medicine Jul 2004Vasopressin is a potent vasopressor for improving organ perfusion during septic shock. The rationale for the use of vasopressin is its relative deficiency of plasma... (Review)
Review
Vasopressin is a potent vasopressor for improving organ perfusion during septic shock. The rationale for the use of vasopressin is its relative deficiency of plasma levels and hypersensitivity to its vasopressor effects during septic shock. Growing evidence suggests that low-dose (<0.04 U/min) vasopressin is safe and effective for the treatment of vasodilatory shock. Although it is being used more frequently, there are no randomized clinical trials comparing vasopressin as a first-line agent to commonly used vasopressors. However, vasopressin causes arterial smooth muscle cell contraction through a non-catecholamine receptor pathway, thus it represents an attractive adjunct to the management of septic shock, especially when catecholamines are ineffective.
Topics: Amino Acid Sequence; Blood Circulation; Blood Pressure; Dose-Response Relationship, Drug; Humans; Lypressin; Models, Biological; Osmolar Concentration; Pulmonary Circulation; Shock, Septic; Terlipressin; Vasoconstrictor Agents; Vasopressins
PubMed: 15103461
DOI: 10.1007/s00134-004-2283-8 -
Current Opinion in Anaesthesiology Apr 2008This article reviews new findings on the use of vasopressor agents in septic shock. (Review)
Review
PURPOSE OF REVIEW
This article reviews new findings on the use of vasopressor agents in septic shock.
RECENT FINDINGS
Several recent large randomized clinical trials have compared vasopressor agents in patients with septic shock. Briefly, the survival of patients treated with norepinephrine alone or a combination of norepinephrine and dobutamine did not significantly differ from that of patients treated with epinephrine. In observational studies, dopamine use was associated with poor outcome. The results of a clinical trial comparing dopamine and norepinephrine as a first-line agent in septic shock are pending. The addition of low-dose vasopressin to norepinephrine did not significantly improve the survival of patients with septic shock. A positive effect on survival was observed in a predetermined (norepinephrine dose <15 microg/kg/min) subgroup of patients with moderate shock. There is no large randomized clinical trial on the use of terlipressin. In contrast, nitric oxide inhibitors were associated with increased mortality in patients with septic shock.
SUMMARY
The use of norepinephrine or epinephrine can be left to the discretion of the treating physician. Low-dose vasopressin administration remains an option for catecholamine-refractory septic shock. The potential benefit of early use in combination with a moderate dose of norepinephrine remains to be determined.
Topics: Humans; Resuscitation; Shock, Septic; Sympathetic Nervous System; Vasoconstrictor Agents; Vasopressins
PubMed: 18443479
DOI: 10.1097/ACO.0b013e3282f46d20 -
The Annals of Pharmacotherapy Sep 2018To review and summarize data on angiotensin II (AT-II), approved by the Food and Drug Administration (FDA) in December 2017 to increase blood pressure in adults with... (Review)
Review
OBJECTIVE
To review and summarize data on angiotensin II (AT-II), approved by the Food and Drug Administration (FDA) in December 2017 to increase blood pressure in adults with septic or other distributive shock.
DATA SOURCES
A PubMed/MEDLINE search was conducted using the following terms: (angiotensin ii OR angiotensin 2) AND (shock) from 1966 to February 2018.
STUDY SELECTION AND DATA EXTRACTION
A total of 691 citations were reviewed with only relevant clinical data extracted.
DATA SYNTHESIS
AT-II is a peptide hormone with a multitude of physiological effects-namely, vasoconstriction of venous and arterial smooth muscle. The priority approval granted by the FDA was secondary to a phase 3 study of patients receiving at least 0.2 µg/kg/min of norepinephrine or equivalent for vasodilatory shock. Compared with placebo, AT-II had a significantly higher rate of response, defined as a mean arterial pressure of 75 mm Hg or an increase of 10 mm Hg. No significant difference was found in death by day 28.
CONCLUSIONS
AT-II is a newly available vasoactive agent with a novel mechanism for the treatment of distributive shock. Further research is needed to define its exact role in therapy of shock states, identify patients most likely to benefit, and further study its safety profile in critical illness.
Topics: Angiotensin II; Animals; Humans; Shock; Treatment Outcome; Vasoconstrictor Agents
PubMed: 29582666
DOI: 10.1177/1060028018767899 -
Axone (Dartmouth, N.S.) Jun 1992
Topics: Humans; Indoles; Migraine Disorders; Sulfonamides; Sumatriptan; Vasoconstrictor Agents
PubMed: 1318067
DOI: No ID Found -
Critical Care (London, England) 2009Use of terlipressin in septic shock relies on a series of European studies resulting in a better knowledge of this vasopressive agent. Additional studies demonstrate...
Use of terlipressin in septic shock relies on a series of European studies resulting in a better knowledge of this vasopressive agent. Additional studies demonstrate that this agent appears to have attractive properties when administered properly. In comparison to prior reports, continuous infusion of low-dose terlipressin seems superior when administered to septic animals. For the first time in humans, Morelli and colleagues compared this mode of administration with other vasopressors.
Topics: Humans; Lypressin; Shock, Septic; Terlipressin; Vasoconstrictor Agents
PubMed: 19832999
DOI: 10.1186/cc8035 -
Critical Care Medicine Jun 2003
Topics: Epinephrine; Humans; Shock, Septic; Splanchnic Circulation; Vasoconstrictor Agents
PubMed: 12794435
DOI: 10.1097/01.CCM.0000063279.00836.25 -
Clinical Transplantation 2012Metabolic management of brain-death organ donors includes correction of the hormonal perturbations that occur after cerebral death and impair circulatory function.... (Review)
Review
BACKGROUND
Metabolic management of brain-death organ donors includes correction of the hormonal perturbations that occur after cerebral death and impair circulatory function. Vasopressin is a hormone secreted by the posterior pituitary gland, which contributes to maintain systemic blood pressure by regulating urine secretion and small arteriole tonus. During brain death, the pituitary gland is damaged and hormone secretion rapidly ceases. Low-dose vasopressin increases systemic blood pressure and decreases the need for catecholamines in brain-dead organ donors but it is not available in many countries. Terlipressin is a synthetic analog of vasopressin characterized by greater selectivity for the V1 receptor than vasopressin. To date, the efficacy of terlipressin as a pressor agent in humans has been reported in a few studies.
METHOD
Pharmacology and literature about the use of terlipressin in shock and in particularly in neurogenic shock following brain death is summarized and our personal experience is reported.
RESULTS AND CONCLUSION
Terlipressin is helpful in controlling severe hypotension; its use allowed to reduce the infusion rate of norepinephrine about 50% in two of three brain-death organ donors, but there are not yet enough data to define its therapeutic range and incidence of collateral effects on the grafts.
Topics: Brain Death; Humans; Hypotension; Lypressin; Organ Transplantation; Terlipressin; Tissue Donors; Vasoconstrictor Agents
PubMed: 23121213
DOI: 10.1111/ctr.12038