Tag: vasopressors
Broad Spectrum Vasopressors
We propose the notion of "broad spectrum vasopressors" wherein patients with septic shock are started on multiple vasopressors with a different mechanism of action simultaneously while the vasopressor sensitivity is assessed.... read more
Epinephrine Challenge in Sepsis: An Empiric Approach to Catecholamines
The critical care world is obsessed with fluid. Meanwhile, little attention has been given to the concepts of vasopressor responsiveness and vasopressor challenge. This is a missed opportunity, because vasopressor challenges... read more
Effect of Vitamin C and Thiamine on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock
A 2020 randomized trial reported no difference in duration of time alive and free of vasopressor administration at 7 days among intensive care unit (ICU) patients with septic shock assigned to vitamin C, thiamine, and hydrocortisone... read more
Coronavirus (2019-nCoV): Evidence Relevant to Critical Care
The 2019 Coronavirus outbreak was declared a global Public Health Emergency by the World Health Organization (WHO) on 30th January 2020. In order to ensure immediate access to relevant systematic reviews, this Cochrane... read more
Influence of Head-of-bed Elevation on the Measurement of IVC Diameter and Collapsibility
In a population of critically ill patients undergoing goal-directed ultrasound examinations, elevating head-of-bed (HOB) to 30° did not significantly alter inferior vena cava (IVC) measurements or CI. At 45°, however,... read more
Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock
In patients with septic shock, treatment with intravenous vitamin C, hydrocortisone, and thiamine, compared with intravenous hydrocortisone alone, did not significantly improve the duration of time alive and free of vasopressor... read more
Could the Furosemide Stress Test Clarify Resuscitative Goals?
Imagine that you admit a patient with septic shock. You resuscitate the patient as best you can with inopressors, fluids, and antibiotics. An adequate blood pressure is achieved. A reasonable amount of fluid is administered.... read more
Enteral Nutrition Can Be Given to Patients on Vasopressors
Most all recent studies show Enteral Nutrition (EN) can be delivered safely to patients on vasopressors. In fact, many studies show an outcome benefit of early EN (EEN) in ICU patients who are receiving vasopressors. It... read more
Early Identification of Patients at High Risk of Streptococcus-associated Necrotizing Infections
Two simple and available upon admission clinical predictors of group A streptococcus (GAS) documentation identified among a large cohort of surgically proven necrotizing soft tissue infections (NSTIs). The results show... read more
Update to the Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) Protocol
The analyses described here are those necessary to answer the trial's primary question of whether combined treatment with vitamin C, thiamine and steroids is more effective than placebo in increasing days alive and free from... read more
Vasopressin for Acute Hemorrhage?
Vasoactive medications are one of the pillars of management of shock in Emergency Departments. Inopressors, namely Norepinephrine and Epinephrine, are the two most commonly used pressors in US Emergency Departments, used... read more
Use of Vasopressor Increases the Risk of Mortality in Traumatic Hemorrhagic Shock
Use of vasopressor for traumatic hemorrhagic shock was associated with mortality after controlling for biases (trauma severity; volume of fluid resuscitation). Among 236,698 trauma patients, 3,551 were included in the... read more
Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis
In this meta-analysis of 37 RCTs (including 9564 patients), corticosteroid treatment was significantly associated with reduced 28-day mortality, ICU mortality, and in-hospital mortality among patients with sepsis. However,... read more
Early vs. Delayed Administration of Norepinephrine in Patients with Septic Shock
This study investigated the incidence of delayed norepinephrine administration following the onset of septic shock and its effect on hospital mortality. Our results show that early administration of norepinephrine in... read more
Renal Outcomes of Vasopressin and Its Analogs in Distributive Shock
In patients with distributive shock, vasopressin and its analogs use is associated with a reduced need for renal replacement therapy and lower acute kidney injury (AKI) incidence. These results are supported by high risk... read more
Myocardial Ischemia During Ventilator Weaning
This observational study showed the pulmonary edema (WiPO) occurred in a significant number of critically ill patients who failed a first spontaneous breathing trial (SBT), while cardiac ischemia (WiCI) was less frequent.... read more
Vasoactive Medication and Randomized Clinical Trials
Vasoactive medication is one of the cornerstones in the treatment of critically ill patients in shock. Shock can be defined as a failure of the circulatory system to provide adequate tissue perfusion resulting in cellular... read more
Clinical Assessment of Critically Ill Patients by Whole-body Ultrasonography
Critical care ultrasonography (CCUS) is increasingly advocated and used, and is defined as point-of-care image acquisition, interpretation and clinical application, all performed by the critical care clinician, and directed... read more
AKI in Critically Ill Patients After Noncardiac Major Surgery
Acute kidney injury (AKI) is a common complication of major surgery. However, acute kidney injury occurring within the first 48 hours after surgery (early acute kidney injury) and therefore likely related to the surgery itself... read more
Early Norepinephrine Has Potential for Septic Shock
Standard sepsis algorithms have suggested completing a fluid bolus before starting vasopressors in patients with septic shock, but multiple observational trials have shown an association between early vasopressor use and... read more
Cardiovascular Dynamics in Critically Ill Patients
Although widely used among physicians and frequently present in the literature, the words "stable" and "unstable" to describe cardiovascular dynamics in critically ill patients can have different meanings to different people... read more
More Precise Sepsis Therapy with Distinct Clinical Phenotypes
In this retrospective analysis of data sets from patients with sepsis, 4 clinical phenotypes were identified that correlated with host-response patterns and clinical outcomes, and simulations suggested these phenotypes may... read more
