Therapeutic Strategies for High-Dose Vasopressor-Dependent Shock
There is no consensual definition of refractory shock. The use of more than 0.5 mcg/kg/min of norepinephrine or epinephrine to maintain target blood pressure is often used in clinical trials as a threshold. Nearly 6% of critically ill patients will develop refractory shock, which accounts for 18% of...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2013/654708 |
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| author | Estevão Bassi Marcelo Park Luciano Cesar Pontes Azevedo |
| author_facet | Estevão Bassi Marcelo Park Luciano Cesar Pontes Azevedo |
| author_sort | Estevão Bassi |
| collection | DOAJ |
| description | There is no consensual definition of refractory shock. The use of more than 0.5 mcg/kg/min of norepinephrine or epinephrine to maintain target blood pressure is often used in clinical trials as a threshold. Nearly 6% of critically ill patients will develop refractory shock, which accounts for 18% of deaths in intensive care unit. Mortality rates are usually greater than 50%. The assessment of fluid responsiveness and cardiac function can help to guide therapy, and inotropes may be used if hypoperfusion signs persist after initial resuscitation. Arginine vasopressin is frequently used in refractory shock, although definite evidence to support this practice is still missing. Its associations with corticosteroids improved outcome in observational studies and are therefore promising alternatives. Other rescue therapies such as terlipressin, methylene blue, and high-volume isovolemic hemofiltration await more evidence before use in routine practice. |
| format | Article |
| id | doaj-art-bfbfbe05aa2549c5ade8219890663c78 |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-bfbfbe05aa2549c5ade8219890663c782025-02-03T01:11:53ZengWileyCritical Care Research and Practice2090-13052090-13132013-01-01201310.1155/2013/654708654708Therapeutic Strategies for High-Dose Vasopressor-Dependent ShockEstevão Bassi0Marcelo Park1Luciano Cesar Pontes Azevedo2Intensive Care Unit, Discipline of General Surgery and Trauma, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Avenue Eneas de Carvalho Aguiar 255, 4th Floor, 05403-000 São Paulo, SP, BrazilIntensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Avenue Eneas de Carvalho Aguiar 255, Room 5023, 05403-000 São Paulo, SP, BrazilIntensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Avenue Eneas de Carvalho Aguiar 255, Room 5023, 05403-000 São Paulo, SP, BrazilThere is no consensual definition of refractory shock. The use of more than 0.5 mcg/kg/min of norepinephrine or epinephrine to maintain target blood pressure is often used in clinical trials as a threshold. Nearly 6% of critically ill patients will develop refractory shock, which accounts for 18% of deaths in intensive care unit. Mortality rates are usually greater than 50%. The assessment of fluid responsiveness and cardiac function can help to guide therapy, and inotropes may be used if hypoperfusion signs persist after initial resuscitation. Arginine vasopressin is frequently used in refractory shock, although definite evidence to support this practice is still missing. Its associations with corticosteroids improved outcome in observational studies and are therefore promising alternatives. Other rescue therapies such as terlipressin, methylene blue, and high-volume isovolemic hemofiltration await more evidence before use in routine practice.http://dx.doi.org/10.1155/2013/654708 |
| spellingShingle | Estevão Bassi Marcelo Park Luciano Cesar Pontes Azevedo Therapeutic Strategies for High-Dose Vasopressor-Dependent Shock Critical Care Research and Practice |
| title | Therapeutic Strategies for High-Dose Vasopressor-Dependent Shock |
| title_full | Therapeutic Strategies for High-Dose Vasopressor-Dependent Shock |
| title_fullStr | Therapeutic Strategies for High-Dose Vasopressor-Dependent Shock |
| title_full_unstemmed | Therapeutic Strategies for High-Dose Vasopressor-Dependent Shock |
| title_short | Therapeutic Strategies for High-Dose Vasopressor-Dependent Shock |
| title_sort | therapeutic strategies for high dose vasopressor dependent shock |
| url | http://dx.doi.org/10.1155/2013/654708 |
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