Inotropes and Vasopressors

Overgaard, Christopher B.; Džavík, Vladimir

doi:10.1161/circulationaha.107.728840

Cited by 402 publications

(256 citation statements)

References 91 publications

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“…Antibiotics and hemodynamic support, which includes volume resuscitation and use of vasopressors in severe cases are the mainstay therapy (9). Current sepsis treatment guidelines recommend norepinephrine, dopamine and dobutamine as first line vasopressor agents, they may not be the ideal choice in the setting of active or recurrent arrhythmias (9) in view of their pro-arrhythmic properties (33). Despite lack of data to support this, in view of their virtual lack of affinity for beta receptors it appears intuitive to use vasopressors such as phenylephrine and (33).…”

Section: Discussionmentioning

confidence: 99%

Severe sepsis and cardiac arrhythmias

Shahreyar¹,

Fahhoum²,

Akinseye³

et al. 2018

Ann. Transl. Med.

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Background: Although sepsis is a known risk factor for cardiac arrhythmias, data on incidence and outcomes of atrial and ventricular arrhythmias in severe sepsis is limited. The purpose of this study is to examine the association of severe sepsis with cardiac arrhythmias and their impact on outcome in this patient population. Methods:We used hospital discharge data from the Nationwide Inpatient Sample (NIS) during the year 2012. All patients 18 years or older were included in the study. The International Classification of Diseases-Clinical Modification, 9th revision (ICD-9-CM) code was used to identify patients with discharge diagnosis of severe sepsis, atrial fibrillation (A Fib), atrial flutter (AFL), ventricular fibrillation (VF) arrest and non-ventricular fibrillation (non-VF) arrest. In order to study the association of arrhythmias with severe sepsis, two groups were defined: group a-with severe sepsis was compared to group b-without severe sepsis. Univariate and multivariate logistic regression methods were used to adjust for potential confounding factors and variables associated with cardiac arrhythmias were determined.Results: A total of 30,712,524 NIS hospital discharges (weighted for national estimate) were included in our study, of which 1,756,965 (5.7%) had severe sepsis. On multivariate analysis, after adjusting for potential confounders, severe sepsis was associated with higher risk of A Fib (OR, 1.23; 95% CI, 1.21-1.24), AFL (OR, 1.34; 95% CI, 1.30-1.40), VF arrest (OR, 2.58; 95% CI, 2.38-2.79) (OR, 3.31; 95% CI, 3.07-3.57) and non-VF arrest (OR, 4.91; 95% CI,). In the severe sepsis group, cardiac arrhythmia was associated with higher in-hospital mortality (OR, 1.41; 95% CI, 1.37-1.45), length of stay (LOS) >75% quartile (OR, 1.50; 95% CI, 1.46-1.53) and total hospital charges >75% quartile (OR, 1.37; 95% CI, 1.34-1.41). Advanced age, male sex, ischemic heart disease, diabetes mellitus (DM), congestive heart failure (CHF), valvular heart disease, respiratory failure, mechanical ventilation and use of vasopressors were independently associated with cardiac arrhythmias. Conclusions:Patients with severe sepsis are at high risk of atrial and life threatening ventricular arrhythmias. Despite adjustment for potential confounding factors, patients hospitalized with severe sepsis carry a significantly higher risk for cardiac arrest and increased mortality.

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Section: Discussionmentioning

confidence: 99%

Severe sepsis and cardiac arrhythmias

Shahreyar¹,

Fahhoum²,

Akinseye³

et al. 2018

Ann. Transl. Med.

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“…dobutamine) could have potentially caused excessive tachycardia and worsened the transmitral pressure gradient and pulmonary congestion (due to increased EVLWI). 5 This could have led to a deterioration in oxygenation. Arguably, common practices to augment cerebral blood flow in vasospastic areas without compromising myocardial function and oxygenation are not themselves free of complications.…”

Section: Discussionmentioning

confidence: 99%

“…This was in view of the ability of noradrenaline to prevent the reflex bradycardia associated with a raised MAP. 5 However, the physiological parameters worsened (i.e. increased SVR index and EVLWI with decreased cardiac output) following the augmentation of the MAP using a noradrenaline infusion alone.…”

Section: Discussionmentioning

confidence: 99%

“…5 In this way, the patient's blood pressure increased to 160/82 mmHg (mean: 108 mmHg). The SVR index was relatively low after the induction of the anaesthesia, possibly due to anaesthesia-mediated vasodilation; the baseline SVR index was 1,680 dynes.second/cm 5 , which fell to approximately 1,460 dynes.second/cm 5 after induction and then 1,100-1,300 dynes.second/cm 5 before the clipping of the aneurysm (normal range: 2,000-2,400 dynes.second/cm 5 ). Throughout the course of the surgery, any changes in the haemodynamic variables were continuously monitored, including heart rate, MAP, SVV, cardiac output and SVR index.…”

Section: Case Reportmentioning

confidence: 97%

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Use of a Minimally Invasive Cardiac Output Monitor to Optimise Haemodynamics in a Patient with Mitral Valve Disease Undergoing Cerebrovascular Surgery

Al-Mashani

Waje

Salhotra

et al. 2017

SQUMJ

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abstract:Patients with mitral valve disease undergoing cerebrovascular surgery face increased inherent risks due to their associated cardiac comorbidities. As such, the anaesthetic management of such patients is distinctly challenging. Simultaneous consideration of both the cerebrovascular and underlying cardiac conditions determines key anaesthetic issues, as fluids and vasopressors or inotropes need to be titrated according to haemodynamic variables in order to optimise cerebral blood flow without compromising cardiac function. We report a 45-yearold female patient with mild mitral stenosis and moderate-to-severe mitral regurgitation who presented to the Khoula Hospital, Muscat, Oman, in 2016 following a ruptured anterior communicating artery aneurysm requiring urgent surgical intervention. As highlighted in this case, the VolumeView EV1000 ™ (Edwards Lifesciences, Irvine, California, USA) system is a minimially invasive haemodynamic monitor that can help immensely in the perioperative management of such patients.

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“…At higher indusion rates (>10 μg/kg/min), vasoconstriction predominates (5). Dopamine is useful in the management of patients with cardiogenic shock or, at low doses, to augment diuresis (6,13). Like all positive inotropic agents, dopamine can result in myocardial ischemia and may be associated with splanchnic shunting, impairment of gastric mucosal oxygentation, and increased risk of gastrointestinal bleeding.…”

Section: Inotropes With Vasopressor Activitiesmentioning

confidence: 99%

Acute heart failure: vasoactive agents – does it matter?

Macas¹,

Zinkevičiūtė-Žarskienė²

2012

AML

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Acute heart failure (AHF) is defined as the rapid onset of symptoms secondary to abnormal cardiac function. It is a syndrome and has a va riety of potential etiologies. AHF is a very polymorphic conception and can be related with abnormalities in cardiac rhythm, systolic or diastolic dysfunction or preload and afterload mismatch. The cornerstone of ma nagement includes therapy directed towards the underlying cause of heart failure. On the other hand, if the underlying cause is irreversible -a heart assist device or even heart transplantation may be needed. Therefore, while awaiting their availability, vital organ perfusion remains crucial. In these settings, intravenous cardio-/vaso-active agents are necessary.With few exceptions, most vasopressor and positive inotropic agents are symphatomimetic amines that exert their action by binding and stimulating adrenergic receptors. They are powerful drugs with a considerable potential for toxicity.Vasopressor and inotropic support in case of AHF helps to win the time until a more definitive treatment becomes available. Therefore, AHF management must be directed to establish and eliminate deteriorational factors, however, not the correction of particular hemodynamic parameters.

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Inotropes and Vasopressors

Cited by 402 publications

References 91 publications

Severe sepsis and cardiac arrhythmias

Severe sepsis and cardiac arrhythmias

Use of a Minimally Invasive Cardiac Output Monitor to Optimise Haemodynamics in a Patient with Mitral Valve Disease Undergoing Cerebrovascular Surgery

Acute heart failure: vasoactive agents – does it matter?

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