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Mergoum AM, Rhone AR, Larson NJ, Dries DJ, Blondeau B, Rogers FB. A Guide to the Use of Vasopressors and Inotropes for Patients in Shock. J Intensive Care Med 2024:8850666241246230. [PMID: 38613381 DOI: 10.1177/08850666241246230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Shock is a life-threatening circulatory failure that results in inadequate tissue perfusion and oxygenation. Vasopressors and inotropes are vasoactive medications that are vital in increasing systemic vascular resistance and cardiac contractility, respectively, in patients presenting with shock. To be well versed in using these agents is an important skill to have in the critical care setting where patients can frequently exhibit symptoms of shock. In this review, we will discuss the pathophysiological mechanisms of shock and evaluate the current evidence behind the management of shock with an emphasis on vasopressors and inotropes.
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Affiliation(s)
| | | | | | - David J Dries
- Department of Surgery, Regions Hospital, Saint Paul, MN, USA
| | - Benoit Blondeau
- Department of Surgery, Regions Hospital, Saint Paul, MN, USA
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Kurochkin MA, Sindeeva OA, Abdurashitov AS, Pyataev NA, Gorin DA, Sukhorukov GB. In Vivo Laser-Induced Vasoactive Microenvironmental Setting via a Stimuli-Responsive Microstructured Depot. Biomacromolecules 2023. [PMID: 37289998 DOI: 10.1021/acs.biomac.3c00125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A stimuli-responsive polymeric three-dimensional microstructured film (PTMF) is a 3D structure with an array of sealed chambers on its external surface. In this work, we demonstrate the use of PTMF as a laser-triggered stimulus-response system for local in vivo targeted blood vessels stimulation by vasoactive substances. The native vascular networks of the mouse mesentery were used as model tissues. Epinephrine and KCl were used as vasoactive agents that were sealed into individual chambers upon precipitation in the amount of pictograms. We demonstrated the method for non-damaged one-by-one chamber activation using a focused 532 nm laser light passed through biological tissues. To avoid laser-induced photothermal damage to biological tissues, the PTMF was functionalized with Nile Red dye, which effectively absorbs laser light. Chemically stimulated blood vessel fluctuations were analyzed using digital image processing methods. Hemodynamics changes were measured and visualized using the particle image velocimetry approach.
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Affiliation(s)
- Maxim A Kurochkin
- Skolkovo Institute of Science and Technology, 3 Nobelya Str., Moscow 143025, Russia
| | - Olga A Sindeeva
- Skolkovo Institute of Science and Technology, 3 Nobelya Str., Moscow 143025, Russia
| | | | - Nikolay A Pyataev
- National Research Ogarev Mordovia State University, 68 Bolshevistskaya Str., Saransk 430005, Russia
| | - Dmitry A Gorin
- Skolkovo Institute of Science and Technology, 3 Nobelya Str., Moscow 143025, Russia
| | - Gleb B Sukhorukov
- Skolkovo Institute of Science and Technology, 3 Nobelya Str., Moscow 143025, Russia
- School of Engineering and Materials Science, Queen Mary University of London, Mile End road, London E1 4NS, U.K
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Vojnar B, Geldner G, Huljic-Lankinen S, Murst M, Keller T, Weber S, Gaik C, Koch T, Weyland A, Kranke P, Kreuer S, Chappell D, Eberhart L. A randomized open label, parallel-group study to evaluate the hemodynamic effects of Cafedrine/Theodrenaline vs Noradrenaline in the treatment of intraoperative hypotension after induction of general anesthesia: the "HERO" study design and rationale. Curr Med Res Opin 2023; 39:803-810. [PMID: 37211772 DOI: 10.1080/03007995.2023.2213124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/24/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Intraoperative arterial hypotension (IOH) is associated with poor patient outcome. This study aims to compare the hemodynamic effects of Cafedrine/Theodrenaline (C/T) and Noradrenaline (NA) for the treatment of hypotension in patients who develop IOH after anesthesia induction. RESEARCH DESIGN AND METHODS This is a national, randomized, parallel-group, multicenter, and open-label study. Adult patients (≥50 years, ASA-classification III-IV) who undergo elective surgery will be included. When IOH (MAP <70 mmHg) develops, C/T or NA will be given as a bolus injection ("bolus phase", 0-20 min after initial application) and subsequently as continuous infusion ("infusion phase", 21-40 min after initial application) to achieve MAP = 90 mmHg. Hemodynamic data are captured in real time by advanced hemodynamic monitoring. RESULTS Primary endpoints, i.e. the treatment-related difference in average mean arterial pressure (MAP) during the "infusion phase" and the treatment-related difference in average cardiac index during the "bolus phase" are assessed (fixed-sequence method). Non-inferiority of C/T compared to NA in achieving 90 mmHg (MAP) when applied as continuous infusion is hypothesized. In addition, superiority of C/T over NA, applied as bolus injection, in increasing cardiac index is postulated. It is estimated that 172 patients are required to establish statistical significance with a power of 90%. After adjusting for ineligibility and dropout rate, 220 patients will be screened. CONCLUSION This clinical trial will yield evidence for marketing authorization of C/T applied as continuous infusion. Additionally, the effects of C/T compared to NA on cardiac index will be assessed. First results of the "HERO"-study are expected in 2024. DRKS identifier: DRKS00028589. EudraCT identifier: 2021-001954-76.
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Affiliation(s)
- Benjamin Vojnar
- Department of Anesthesiology and Intensive Care, Philipps-University Marburg, Marburg, Germany
| | - Götz Geldner
- Clinic for Intensive Care, Emergency Medicine and Pain Therapy, Hospital Ludwigsburg, Ludwigsburg, Germany
| | | | | | | | | | - Christine Gaik
- Department of Anesthesiology and Intensive Care, Philipps-University Marburg, Marburg, Germany
| | - Tilo Koch
- Department of Anesthesiology and Intensive Care, Philipps-University Marburg, Marburg, Germany
| | - Andreas Weyland
- Research Center Neurosensory Science, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Peter Kranke
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Sascha Kreuer
- Department of Anesthesiology, Intensive Care and Pain Therapy, Saarland University Faculty of Medicine, Homburg, Germany
| | - Daniel Chappell
- Department of Anesthesiology and Intensive Care, Varisano Hospital Frankfurt-Höchst, Frankfurt, Germany
| | - Leopold Eberhart
- Department of Anesthesiology and Intensive Care, Philipps-University Marburg, Marburg, Germany
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Curran J, Burkhoff D, Kloner RA. Beyond Reperfusion: Acute Ventricular Unloading and Cardioprotection During Myocardial Infarction. J Cardiovasc Transl Res 2019; 12:95-106. [PMID: 30671717 PMCID: PMC6497619 DOI: 10.1007/s12265-019-9863-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/02/2019] [Indexed: 12/21/2022]
Abstract
Heart failure is a major cause of morbidity and mortality around the world, and myocardial infarction is its leading cause. Myocardial infarction destroys viable myocardium, and this dead tissue is replaced by a non-contractile scar that results in impaired cardiac function and a significantly increased likelihood of the patient developing heart failure. Limiting infarct scar size has been the target of pre-clinical and clinical investigations for decades. However, beyond reperfusion, few therapies have translated into the clinic that limit its formation. New approaches are needed. This review will focus on new clinical and pre-clinical data demonstrating that acute ventricular unloading prior to reperfusion by means of percutaneous left ventricular support devices reduces ischemia-reperfusion injury and limits infarct scar size. Emphasis will be given to summarizing our current mechanistic understanding of this new therapeutic approach to treating myocardial infarction.
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Affiliation(s)
| | | | - Robert A Kloner
- Huntington Medical Research Institutes, Pasadena, CA, USA
- University of Southern California, Los Angeles, CA, USA
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Brindley PG, O'Dochartaigh D, Volney C, Ryan S, Douma MJ. Time delays associated with vasoactive medication preparation and delivery in simulated patients at risk of cardiac arrest. J Crit Care 2017; 40:149-153. [PMID: 28402925 DOI: 10.1016/j.jcrc.2017.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare, quantify, and describe the time-delays associated with four common methods of adrenaline administration in the simulated setting of impending cardiac arrest. METHODS Using sham medication and a high-fidelity simulator, experienced Nurses prepared, then delivered, adrenaline by: i) bolus, ii) lower-concentration infusion iii) higher-concentration infusion, and iv) higher-concentration infusion plus carrier-line. We recorded medication preparation and delivery time, plus administration errors and self-reported competence. RESULTS Median total delay was i) 120s for bolus (95% CI 112-128s); ii) 179s for lower concentration infusion (95% CI 172-186s); iii) 296s for higher concentration infusion (95% CI 285-307s); and iv) 411s for higher concentration infusion plus carrier line (95% CI 399-423s). Time to prepare/deliver a bolus was less than any infusion (p<0.001). Time to prepare/deliver a lower-concentration infusion was less than either higher-concentration infusion (p<0.001). No substantial equipment failures or medication errors were observed. Participants reported high-competence. The majority of delay was from drug preparation not delivery. CONCLUSIONS We highlight potentially dangerous delays with administration of life-saving medications by all four methods. We should prioritize boluses, and focus on improving drug preparation times and human performance, more than drug delivery and equipment.
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Affiliation(s)
- P G Brindley
- Critical Care Medicine, Medical Ethics, Anesthesiology, University of Alberta Hospital, Edmonton, Alberta T6G2B7, Canada.
| | - D O'Dochartaigh
- Shock Trauma Air Rescue Society, Emergency Departments Edmonton Zone, RM 1G1:55, Department of Emergency Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada.
| | - C Volney
- Saba University School of Medicine Dutch Caribbean, Netherlands
| | - S Ryan
- Shock Trauma Air Rescue Service, Edmonton, Alberta, Canada.
| | - M J Douma
- Royal Alexandra Hospital Emergency Department, Edmonton, Alberta, Canada.
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García-Canales A, Peña-Juárez RA, Sandoval-Franco LDM. [Vasopressors and inotropes: use in paediatrics]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 88:39-50. [PMID: 28336302 DOI: 10.1016/j.acmx.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/16/2022] Open
Abstract
The cardiovascular system is a dynamic system, which is required to ensure adequate delivery of oxygen, nutrients, and hormones to the tissues that are necessary for cell metabolism. It also synthesises and modifies the vasoactive components that regulate vascular tone and myocardial function. These vasoactive components have demonstrated their beneficial effects in the management of paediatric patients in a critical condition with heart failure and shock. However, their use and abuse brings harmful effects, increases mortality, and is associated with arrhythmias. An increase in myocardial oxygen consumption favours the presence of ischaemia, therefore it is necessary to know the mechanism of action and indications of these drugs to minimise their harmful effects. The purpose of this review is to describe the pharmacology and clinical applications of inotropic and vasopressor agents in the paediatric patient in acritical condition.
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Affiliation(s)
- Adrián García-Canales
- Departamento de Terapia Intensiva Pediátrica, Hospital Regional Valentín Gómez Farías, ISSSTE, Zapopan, Jalisco, México.
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Influence of postoperative vasoactive agent administration on free flap outcomes. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1223-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bipat R, Toelsie JR, Magali I, Soekhoe R, Stender K, Wangsawirana A, Oedairadjsingh K, Pawirodihardjo J, Mans DRA. Beneficial effect of medicinal plants on the contractility of post-hypoxic isolated guinea pig atria - Potential implications for the treatment of ischemic-reperfusion injury. PHARMACEUTICAL BIOLOGY 2016; 54:1483-1489. [PMID: 26730936 DOI: 10.3109/13880209.2015.1107103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Context Ischemic-reperfusion injury is accompanied by a decreased contractility of the myocardium. Positive-inotropic agents have proven useful for treating this condition but may exert serious side-effects. Objective In this study, aqueous preparations from Abelmoschus esculentus L. Moench (Malvaceae), Annona muricata L. (Annonaceae), Bixa orellana L. (Bixaceae), Cecropia peltata L. (Moraceae), Erythrina fusca Lour. (Fabaceae), Psidium guajava L. (Myrtaceae) and Terminalia catappa L. (Combretaceae) were evaluated for their ability to improve the decreased contractility of isolated guinea pig atria after hypoxic stress. Materials and methods Guinea pig atria isolated in Ringer-Locke buffer gassed with 100% O2 at 30 °C were exposed for 5 min to hypoxia, then allowed to recover in oxygenated buffer alone or containing a single plant extract (0.001-1 mg/mL). The contractility (g/s) and beating frequency (beats/min), as well as troponin C contents of the bathing solution (ng/mL), were determined and expressed as means ± SDs. Results The extracts of A. muricata, B. orellana, C. peltata and T. catappa caused an increase in the contractility compared to untreated atria of 340 ± 102%, 151 ± 13%, 141 ± 14% and 238 ± 44%, respectively. However, the latter two preparations increased the troponin C contents of the bathing solution to 36 ± 11 and 69 ± 33, compared to the value of 11 ± 3 ng/mL found with untreated atria. Conclusions Preparations from A. muricata and B. orellana may possess positive-inotropic properties which may improve the contractility of the post-hypoxic myocardium. Studies to assess their usefulness in ischemic-reperfusion injury are warranted.
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Affiliation(s)
- Robbert Bipat
- a Department of Physiology, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
| | - Jerry R Toelsie
- a Department of Physiology, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
| | - Indira Magali
- a Department of Physiology, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
- b Department of Pharmacology, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
| | - Rubaina Soekhoe
- a Department of Physiology, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
- b Department of Pharmacology, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
| | - Karin Stender
- c Department of Pharmacy , University of Utrecht , Utrecht , The Netherlands
| | - Angelique Wangsawirana
- d Department of Clinical Chemistry , University of Groningen , Groningen , The Netherlands
| | - Krishan Oedairadjsingh
- a Department of Physiology, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
- b Department of Pharmacology, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
| | - Jennifer Pawirodihardjo
- a Department of Physiology, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
- b Department of Pharmacology, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
| | - Dennis R A Mans
- b Department of Pharmacology, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
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