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Future Cardiology Nov 2020Shock is an acute condition of circulatory failure resulting in life-threatening organ dysfunction, high morbidity and high mortality. Current management includes fluid... (Review)
Review
Shock is an acute condition of circulatory failure resulting in life-threatening organ dysfunction, high morbidity and high mortality. Current management includes fluid and catecholamine therapy to maintain adequate mean arterial pressure and organ perfusion. Norepinephrine is recommended as first-line vasopressor, but other agents are available. Angiotensin II is an alternative potent vasoconstrictor without chronotropic or inotropic properties. Several studies, including a large randomized controlled trial have demonstrated its ability to increase blood pressure with catecholamine-sparing effects. Angiotensin II was consequently approved by the US FDA in 2017 and the EU in 2019 as an add-on vasopressor in vasodilatory shock. This review aims to discuss its basic pharmacology, clinical efficacy, safety and future perspectives.
Topics: Angiotensin II; Blood Pressure; Humans; Randomized Controlled Trials as Topic; Shock; Vasoconstrictor Agents; Vasodilation
PubMed: 32462921
DOI: 10.2217/fca-2020-0019 -
Journal of Burn Care & Research :... Mar 2023Acute burn surgery has long been associated with significant intra-operative bleeding. Several techniques were introduced to limit hemorrhage, including tourniquets,...
Acute burn surgery has long been associated with significant intra-operative bleeding. Several techniques were introduced to limit hemorrhage, including tourniquets, tumescent infiltration, and topical agents. To date, no study has comprehensively investigated the available data regarding topical hemostatic agents in burn surgery. A systematic review was performed by two independent reviewers using electronic databases (PubMed, Scopus, Web of Science) from first available to September 10, 2021. Articles were included if they were published in English and described or evaluated topical hemostatic agents used in burn excision and/or grafting. Data were extracted on the agent(s) used, their dosage, mode of delivery, hemostasis outcomes, and complications. The search identified 1982 nonduplicate citations, of which 134 underwent full-text review, and 49 met inclusion criteria. In total, 32 studies incorporated a vasoconstrictor agent, and 28 studies incorporated a procoagulant agent. Four studies incorporated other agents (hydrogen peroxide, tranexamic acid, collagen sheets, and TT-173). The most common vasoconstrictor used was epinephrine, with doses ranging from 1:1000 to 1:1,000,000. The most common procoagulant used was thrombin, with doses ranging from 10 to 1000 IU/ml. Among the comparative studies, outcomes of blood loss were not reported in a consistent manner, therefore meta-analysis could not be performed. The majority of studies (94%) were level of evidence III-V. Determining the optimal topical hemostatic agent is limited by low-quality data and challenges with consistent reporting of intra-operative blood loss. Given the routine use of topical hemostatic agents in burn surgery, high-quality research is essential to determine the optimal agent, dosage, and mode of delivery.
Topics: Humans; Burns; Administration, Topical; Vasoconstrictor Agents; Blood Loss, Surgical; Hemostatics; Antifibrinolytic Agents
PubMed: 36516423
DOI: 10.1093/jbcr/irac185 -
The Nursing Clinics of North America Mar 2016Health care providers should be aware of the pharmacotherapy considerations in the American Heart Association's guidelines for advanced cardiac life support (ACLS).... (Review)
Review
Health care providers should be aware of the pharmacotherapy considerations in the American Heart Association's guidelines for advanced cardiac life support (ACLS). Current evidence does not suggest a reduction in mortality with ACLS medications; however, these medications can improve return of spontaneous circulation. Proper agent selection and dosing are imperative to maximize benefit and minimize harm. The latest guideline update included major changes to the ventricular fibrillation/pulseless ventricular tachycardia and pulseless electrical activity/asystole algorithms, which providers should adopt. It is critical that providers be prepared for post-code management. Health care professionals should remain abreast of changing evidence and guidelines.
Topics: Advanced Cardiac Life Support; American Heart Association; Bronchodilator Agents; Disease Management; Heart Arrest; Humans; Practice Guidelines as Topic; Tachycardia, Ventricular; United States; Vasoconstrictor Agents; Ventricular Fibrillation
PubMed: 26897425
DOI: 10.1016/j.cnur.2015.10.003 -
The Journal of Allergy and Clinical... Jul 1994
Topics: Adult; Conjunctivitis; Female; Humans; Male; Ophthalmic Solutions; Skin Tests; Time Factors; Vasoconstrictor Agents
PubMed: 8027493
DOI: 10.1016/0091-6749(94)90081-7 -
Critical Care Medicine May 2000
Topics: Animals; Cardiopulmonary Resuscitation; Dose-Response Relationship, Drug; Epinephrine; Esophagus; Humans; Intubation; Intubation, Intratracheal; Swine; Treatment Failure; Vasoconstrictor Agents
PubMed: 10834743
DOI: 10.1097/00003246-200005000-00081 -
Intensive & Critical Care Nursing Aug 2024
Topics: Humans; Pressure Ulcer; Vasoconstrictor Agents; Risk Factors
PubMed: 38636294
DOI: 10.1016/j.iccn.2024.103702 -
Journal of Pharmacy Practice Aug 2020The objective of this article is to discuss the pharmacology, side effects, and clinical application of vasoactive therapy in the management of adult septic shock. (Review)
Review
PURPOSE
The objective of this article is to discuss the pharmacology, side effects, and clinical application of vasoactive therapy in the management of adult septic shock.
SUMMARY
Sepsis is one of the most common reasons for admission to an intensive care unit with the incidence estimated to be greater than 750 000 cases per year in the United States. Clinicians should understand the basic pharmacology of available vasoactive agents to allow for routine and complex management of septic shock.
CONCLUSION
While advances in research, identification, and early implementation of best practices for the treatment of sepsis has reduced mortality, rates remain high. Vasopressors and inotropes remain part of the core therapeutic modalities of sepsis management. Norepinephrine is the first-line vasopressor of choice for septic shock, though secondary vasopressors can be used depending on the patient's circumstances.
Topics: Adult; Humans; Intensive Care Units; Norepinephrine; Shock, Septic; Vasoconstrictor Agents
PubMed: 31057085
DOI: 10.1177/0897190019844124 -
AACN Advanced Critical Care 2008
Review
Topics: Cardiotonic Agents; Critical Care; Drug Interactions; Hemodynamics; Humans; Respiratory Distress Syndrome; Shock; Vasoconstrictor Agents
PubMed: 18418098
DOI: 10.1097/01.AACN.0000310743.32298.1d -
Canadian Journal of Anaesthesia =... May 1994Although spinal and epidural blocks provide excellent anaesthesia for many operations, they are frequently accompanied by hypotension. This is largely the result of... (Review)
Review
Although spinal and epidural blocks provide excellent anaesthesia for many operations, they are frequently accompanied by hypotension. This is largely the result of sympathetic nerve blockade. Excessive hypotension may potentially produce myocardial and cerebral ischaemia, and is associated with neonatal acidaemia in obstetric practice. How to prevent and treat this hypotension has been the subject of much investigation and controversy. One of the mainstays of management is the use of vasopressor agents and those currently available are not perfect. In this review, the role of vasopressor agents is discussed and possible future management strategies are commented upon. Ephedrine was the first agent used for this purpose and it has withstood the test of time: it is the agent against which all others are compared. It remains the first-line agent in obstetric anaesthesia as it does not affect the fetus adversely, but it cannot be relied upon to be 100% successful and other agents must be considered when it is inadequate. It is best given by infusion. In non-obstetric practice, ephedrine has a good track record but again its success rate is less than 100%. As there is no fetus to consider, it may be more appropriate to consider using a pure vasoconstrictor agent such as methoxamine or phenylephrine as a first-line therapy in such cases. This judgment can only be made on an individual patient basis as ephedrine produces a tachycardia while phenylephrine and methoxamine both produce bradycardia.
Topics: Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthesia, Spinal; Anesthetics; Ephedrine; Humans; Hypotension; Vasoconstrictor Agents
PubMed: 8055608
DOI: 10.1007/BF03009863 -
Arquivos de Neuro-psiquiatria Mar 2000Brain death results in the breakdown of effective central regulatory mechanisms of cardiocirculatory stability, even in patients with artificial mechanical ventilation,... (Review)
Review
Brain death results in the breakdown of effective central regulatory mechanisms of cardiocirculatory stability, even in patients with artificial mechanical ventilation, correction of electrolytic and acid-basic disorders and maximal conventional pharmacological support of the circulation. Recent evidences have shown that the fall of vasopressin levels in the blood circulation significantly influences the cardiocirculatory stability of patients with brain death, and its exogenous administration is defended by many authors for the management of multiorgan donor patients. In this brief review we analyse and discuss some experimental and clinical relevant studies about the role of vasopressin in the control of cardiocirculatory stability in brain death, and its potential usefulness in the management of multiorgan donor. We conclude that the role of vasopressin in the pathophysiology of brain death and its usefulness as a pharmacological agent in the management of multiorgan donor are not well elucidated, deserving further investigations.
Topics: Brain Death; Coronary Circulation; Hemodynamics; Humans; Tissue Donors; Vasoconstrictor Agents; Vasopressins
PubMed: 10770887
DOI: 10.1590/s0004-282x2000000100029