Hemodynamic support

If in shock, use norepinephrine or epinephrine continuous IV infusion for hemodynamic support... 

Hollenberg SM, Ahrens TS, Annane D, et al. Practice parameters for hemodynamic support of sepsis in adult patients. 2004 update. Crit Care Med 2004 32 1928-1948. 

Maintain fluid and hemodynamic support Expect normal mentation after recovery... 

Over the years, focus has shifted to developing pumps that can be deployed in the catheterization laboratory. Percutaneous LVADs have been developed for rapid deployment in the catheterization laboratory to provide short-term hemodynamic support without the risks of major surgery. The spectrum of percutaneous circulatory... 

A 39-year-old man with diabetes, stabilized with insulin 22 U/day for 13 years, received interferon beta (6 MU/ day) for chronic hepatitis C. His diabetes progressively worsened, necessitating insulin 50 U/day. After 4 weeks, interferon beta was replaced by interferon alfa (10 MU/ day). Shortly afterwards he developed severe diabetic ketoacidosis and shock, which reversed after hemodynamic support and continuous hemodiafiltration. 

A 58-year-old female has undergone surgery for a necrotic bowel. Despite having been treated with antibiotics, on postoperative day 5, she develops symptoms (fever, hypotension, tachycardia, declining urine output, and confusion) consistent with septic shock. To manage her care, what hemodynamic support would be helpful ... 

Anon. 1995 Controlled clinical evaluation of enalapril in dogs with heart failure results of the Cooperative Veterinary Enalapril Study Group. Journal of Veterinary Internal Medicine 9 243-252 Anon. 1999 Practice parameters for hemodynamic support of sepsis in adult patients In sepsis. Task Force of the American Coliege of Critical Care Medicine, Society of Criticai Care Medicine. Criticai Care Medicine 27 639-660... 

Holbeck S, Grande P-0 2000 Effects on capillary fluid permeability and fluid exchange of albumin, dextran, gelatin, and hydroxyethyl starch In cat skeletal muscle. Critical Care Medicine 28 1089-1095 Hollenberg S M, Ahrens T S, Astiz M E 1999 Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Critical Care Medicine 27 639-660... 

Dopamine typically is used as an initial vasopressor agent for hemodynamic support but is limited by its ability to increase cardiac output (by only 35%). Its use is frequently complicated by tachycardia and tachydysrhythmias and occasionally by an increase in PAOP. In contrast to norepinephrine, it decreases splanchnic oxygen use. Low-dose dopamine should not be used to prevent renal failure. 

Vasopressin is emerging as a potentially useful therapy in the hemodynamic support of vasodilatory septic shock. Case series and small clinical trials have reported its use in patients who remain hypotensive on vasopressors. Arginine vasopressin has little pressor activity in normal subjects but markedly increases blood pressure when sympathetic nerve function is impaired, including in septic shock. Unlike the catecholamine vasopressors, vasopressin is a direct vasoconstrictor agent and does not have inotropic or chronotropic effects. As a result, it may decrease cardiac output and hepatosplanchnic flow. In fact, studies of vasopressin in septic shock generally do not enroll patients with a cardiac index of less than 2 to 2.5 L/m per minute. 

The algorithmic approach (see Fig. 23-3) that we recommend regarding the use of vasopressors and inotropes in the hemodynamic support of critically ill septic patients is consistent with the recommendations made in the Surviving Sepsis Campaign" and the... 

Vincent JL. Hemodynamic support in septic shock. Intensive Care Med 2001 27 S80-92. 

Allen TK, George RB, White WD, Muir HA, Habib AS. A double-blind, placebo-controlled trial of four fixed rate infusion regimens of phenylephrine for hemodynamic support during spinal anesthesia for cesarean delivery. Anesth Anaig 2010 111(5) 1221-9. 

In a single-center non-randomized study in patients undergoing primary cardiac operations, 3334 were given aprotinin and 3417 were not [203 ]. The former were older, and had more unstable symptoms, lower ejection fractions, more preoperative hemodynamic support, more urgent operations, and more combined coronary or valvular operations. Postoperative bleeding and blood product transfusion were considerably reduced by aprotinin, as was median duration of mechanical ventilation. Aprotinin was not related to postoperative myocardial infarction, renal insufficiency, neurological dysfunction, or operative death. 

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