ESICM Regional Conference Athens 2017: Management of shock – DRUGS

Vasopressors (A Gordon)

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 Authors Authors and affiliations

Comparison of Dopamine and Norepinephrine in the Treatment of Shock

Vasopressors for hypotensive shock (Cochrane review)

Catecholamines for shock – equally good or equally bad? – Singer

Issue with adrenaline is that lactate becomes hard to use as a target for therapy.

Association Between US Norepinephrine Shortage and Mortality Among Patients With Septic Shock

Vasopressin in shock – vasoconstrictor, V1 receptor on vascular smooth muscle, binds to V2 and oxytocin receptor. Septic shock – relative vasopressin deficiency

The VANISH Randomized Clinical Trial

Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery: The VANCS Randomized Controlled Trial

Future trials on – angiotensin II, selepressin

Gordon – 1st line = noradrenaline. Will escalate to vasopressin (up to 0.06U/min). No dopamine.

Inotropes (A Mebazaa)

IMG_1090

Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance

  • the guidance advocates the use of lung ultrasound in the acute phase to help guide therapy

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

The Effectiveness of Inodilators in Reducing Short Term Mortality among Patient with Severe Cardiogenic Shock: A Propensity-Based Analysis

  • The initial use of inopressors alone appears to be associated with a poorer prognosis compared to a regimen of inopressors and inodilators in patients who are admitted for cardiogenic shock.

Pulmonary hypertension management (S Orfanos)

PULMONARY HYPERTENSION (GUIDELINES ON DIAGNOSIS AND TREATMENT OF)

Comprehensive Invasive and Noninvasive Approach to the Right Ventricle–Pulmonary Circulation Unit

IMG_1093

Prognostic factors and outcomes of patients with pulmonary hypertension admitted to the intensive care unit

Prostacyclin can reduce PVR and improve RV function but caution in LV failure. It can exacerbate V/Q mismatch leading to worsening gas exchange and hypoxaemia

Inhaled NO potent pulmonary vasodilator

Is there a safe plateau pressure in ARDS? The right heart only knows.