Cardiogenic shock – an inflammatory disease

Gisslinger, Heinz

doi:10.1007/s00508-006-0630-1

Cited by 5 publications

(4 citation statements)

References 35 publications

(51 reference statements)

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“…Cardiogenic shock was diagnosed in patients presenting with (a) systolic blood pressure <90 mmHg without the use of inotropes or vasopressors or requirement for vasopressors, (b) signs of decreased cardiac output (low cardiac output measured by any method, low mixed or central venous oxygen saturation), (c) clinical, echocardiographic or radiological signs of pulmonary congestion, (d) absence of hypovolemia and (e) signs of organ malperfusion (e.g., oliguria, cyanosis, lactate, change in mental status) [ 21 , 22 ]. If available, noninvasive and invasive measurements of hemodynamics were considered for diagnosis, although these methods were not a prerequisite for diagnosis of cardiogenic shock [ 23 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

Outcome and features of acute kidney injury complicating hypoxic hepatitis at the medical intensive care unit

Drolz

Horvatits

Roedl

et al. 2016

Ann. Intensive Care

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BackgroundHypoxic hepatitis (HH) is a frequent and potentially life-threatening event typically occurring in critically ill patients as a consequence of hemodynamic impairment. While acute kidney injury (AKI) has been well described in patients with acute liver failure, incidence and outcome of AKI accompanying HH are unclear. The aim of this study was to assess incidence, clinical implications and outcome of AKI and renal replacement therapy (RRT) in critically ill patients with HH.MethodsA total of 1948 consecutive critically ill admissions were studied at the Medical University of Vienna. Laboratory and clinical parameters as well as the presence of HH and AKI were assessed on a daily basis. Outcome, renal recovery and length of stay were assessed and documented, and patients were followed for 1 year.ResultsA total of 295 admissions (15 %) developed HH. Main precipitators were cardiogenic (44 %) and septic shock (36 %). Occurrence of HH was significantly associated with AKI [OR 4.50 (95 % CI 3.30–6.12)] and necessity of renal replacement therapy [RRT; OR 3.36 (95 % CI 2.58–4.37)], p < 0.001 for both. Two hundred forty admissions with HH (81 %) developed AKI, 159 of whom (66 %) had AKI stage 3. Both HH and AKI were significantly linked to mortality. AKI stage 3, international normalized ratio (INR, during HH) and the presence of septic shock were identified as independent predictors of 28-day mortality in admissions with HH, whereas RRT was identified as an independent protective factor. There was a synergistic effect of HH and AKI on length of stay at the ICU. Of all HH survivors treated with RRT, 71 % showed renal recovery during follow-up.ConclusionHH is frequently complicated by occurrence of AKI. Severity of HH, AKI stage and the presence of septic shock seem to contribute to poor outcome in these patients. Initiation of RRT in HH with AKI may enable renal recovery and should not be withheld in medical ICU patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0162-4) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Outcome and features of acute kidney injury complicating hypoxic hepatitis at the medical intensive care unit

Drolz

Horvatits

Roedl

et al. 2016

Ann. Intensive Care

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“…4 The clinical definition of cardiogenic shock is decreased cardiac output with evidence of tissue hypoperfusion, in the presence of adequate circulating blood volume. 4 The clinical definition of cardiogenic shock is decreased cardiac output with evidence of tissue hypoperfusion, in the presence of adequate circulating blood volume.…”

Section: Definitionmentioning

confidence: 99%

“…[1][2][3][4][5]14,15 However, it is not uncommon for cardiogenic shock to occur after a smaller infarction. [1][2][3][4][5]14,15 However, it is not uncommon for cardiogenic shock to occur after a smaller infarction.…”

Section: Causes and Epidemiologymentioning

confidence: 99%

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2008

Dimensions of Critical Care Nursing

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Despite advances in treatment, the mortality rate of patients who develop cardiogenic shock after an acute myocardial infarction remains unacceptably high. This article presents an overview of cardiogenic shockVincidence, epidemiology, predisposing factors, pathophysiology, and management, both medical and surgical.The past 4 decades have seen a dramatic change in our understanding and treatment of myocardial infarction (MI) and acute coronary syndrome (ACS). However, in spite of the progress that has been achieved for ACS, the same has not been accomplished for the treatment of cardiogenic shock. 1 To date, our best treatments for cardiogenic shock continue to be our best treatment practices for ACS. Because of more aggressive strategies to achieve early revascularization, the mortality rate for cardiogenic shock has declined in the past decade or so from 60.3% to 47.9%. 1,2 Nevertheless, the overall mortality rate for this most serious complication of MI remains unacceptably high at best.Observations from the Should We Emergently Revascularize Occluded Coronaries in Cardiogenic Shock (SHOCK) registry have indicated that there may be an inflammatory process that is involved with the development and continuation of cardiogenic shock. 3 Recently, the Triumph study 1 sought to demonstrate that interruption of the inflammatory process would improve mortality. Disappointingly, the study was stopped early. In spite of this, our increasing understanding of the pathophysiology of cardiogenic shock may lead to a more effective breakthrough for this devastating condition. For now, our best approaches to treating cardiogenic shock are to make certain that early revascularization for all appropriate patients occurs and to aggressively look for and provide early treatment for all patients who are at risk of developing cardiogenic shock. INCIDENCE AND TREATMENT TRENDSCardiogenic shock occurs in 5% to 10% of patients who experience an MI. [8][9][10][11]21 Several studies have documented that the incidence of cardiogenic shock was between 7.5% and 7.6%. These include the Worcester Heart Attack Study, 8 a communitywide study that followed all residents who had the diagnosis of MI in Worcester,

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