Tag: hemodynamics
A Trial of Goal-oriented Hemodynamic Therapy in Critically Ill Patients
Hemodynamic therapy aimed at achieving supranormal values for the cardiac index or normal values for mixed venous oxygen saturation does not reduce morbidity or mortality among critically ill patients. A total of 10,726 patients... read more
Angiotensin II For Septic Shock Treatment
Angiotensin II has been studied for many years and has consistently shown to increase MAP. This medication adds a new mechanism of action to the vasopressor arsenal that is already used for septic shock. Angiotensin II should... read more
Lactate-Guided Resuscitation Only Encourages Over-Resuscitation and Downstream Harms
The Centers for Medicare and Medicaid Services and the Surviving Sepsis Campaign both rushed to offer guidance on the appropriate management strategies for patients presenting with septic shock. In both cases, a lactate-guided... read more
A Pilot Study Evaluating the Effect of Cooler Dialysate Temperature on Hemodynamic Stability During Prolonged Intermittent RRT in AKI
Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is associated with high morbidity and mortality. Complications of renal replacement therapy include hemodynamic instability with ensuing shortened treatments,... read more
Snapshots of Hemodynamics: An Aid for Clinical Research and Graduate Education
This new edition reviews recent developments in genetics and molecular biology and new noninvasive measurement techniques that have enabled vast improvements in the measurement and understanding of cardiovascular hemodynamics.... read more
Determination of Brain Death Under Extracorporeal Life Support
The worldwide use of extracorporeal lung/life support is increasing in severe lung failure (veno-venous extracorporeal membrane oxygenation, vvECMO) or in cardiac arrest/severe circulatory failure (veno-arterial ECMO, vaECMO).... read more
Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation
In patients presenting to the emergency department with recent-onset, symptomatic atrial fibrillation, a wait-and-see approach was noninferior to early cardioversion in achieving a return to sinus rhythm at 4 weeks. The presence... read more
Mythbuster: Administration of Vasopressors Through Peripheral Intravenous Access
Vasopressors are frequently used in critically ill patients with hemodynamic instability both in the emergency department (ED) as well as intensive care units (ICUs). Typically, vasopressors are given through central venous... read more
Should We Stop Trending Lactate in Septic Shock?
There may be a tendency to cement guideline recommendations into our collective minds as inalienable and sacrosanct – as if carved onto stone tablets and brought down to us from the heights of Mount Sinai. Thoughtful medicine,... read more
Optimizing Hemodynamic Support in Severe Sepsis and Septic Shock, An Issue of Critical Care Clinics
Guest Editor Dane Nichols, MD, has assembled a panel of experts focusing on Hemodynamic Support in Septic Shock. Topics include: Oxygen Delivery and Consumption: A Macro-Circulatory Perspective; Mean Arterial Pressure: Therapeutic... read more
Medicating patients during extracorporeal membrane oxygenation
Extracorporeal membrane oxygenation (ECMO), which can support gas exchange or hemodynamics in patients with severe respiratory or cardiac failure, has demonstrated considerable evolution over the last decade [1], with a steady... read more
Hemodynamic Support after Cardiac Surgery
Low cardiac output syndrome is a common complication of cardiac surgery and is associated with increased mortality. Levosimendan has been shown in small studies to be an effective therapy.... read more
Unintended Consequences: Fluid Resuscitation Worsens Shock in an Ovine Model of Endotoxemia
Fluid resuscitation resulted in a paradoxical increase in vasopressor requirement. Additionally, it did not result in improvements in any of the measured microcirculatory- or organ-specific markers measured. The increase... read more
Less or More Hemodynamic Monitoring in Critically Ill Patients
The use of echocardiography should be initially encouraged in patients with shock to identify the type of shock and to select the most appropriate therapy. The use of more invasive hemodynamic monitoring techniques should... read more
The Shocked Intubation: Definitive Airway Sans Hypotension
Not many aspects of Emergency Medicine define our specialty better than resuscitation, and few concepts exemplify resuscitation better than shock and intubation. Yet few words together strike greater fear in the minds of... read more
Predicting the Haemodynamic Response to Prone Positioning
A Novel and Simultaneous Analysis of the Guyton and Rahn Diagrams. Graphical models of physiology are heuristically appealing as they facilitate qualitative conclusions at the bedside of the critically ill. Historically,... read more
Fluid Responsiveness in a Hemodynamically Unstable Patient
Only half of patients who are hemodynamically unstable will respond to a fluid bolus. There are no historical or physical examination findings that can help us decide whether a patient is a fluid responder, but we must treat... read more
Hemodynamic Monitoring: Invasive and Noninvasive Clinical Application
Praised by nursing students for its straightforward language and readability, this interdisciplinary reference on bedside hemodynamic monitoring covers the technical aspects of clinical monitoring, including diagnostic and... read more
Transient Systolic Anterior Motion with Junctional Rhythm After Mitral Valve Repair in the ICU
This case report shows that junctional rhythm can cause deterioration of SAM, LVOTO, and MR, and can lead to unstable hemodynamics in a patient with right ventricular failure after MVR. Atrial pacing can resolve SAM, LVOTO,... read more
Assessment of the adequacy of oxygen delivery
In this article, we review physiologic principles of global oxygen delivery, and discuss the bedside approach to assessing the adequacy of oxygen delivery in critically ill patients. Although there have been technological... read more
Surviving Refractory Out-of-Hospital Ventricular Fibrillation Cardiac Arrest
Multi-system organ failure is ubiquitous but treatable with adequate hemodynamic support. Neurologic recovery was prolonged requiring delayed prognostication. Immediate 24/7 availability of surgical and medical specialty... read more
