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Yao H, Liu S, Zhang Z, Xiao Z, Li D, Yi Z, Huang Y, Zhou H, Yang Y, Zhang W. A bibliometric analysis of sepsis-induced myocardial dysfunction from 2002 to 2022. Front Cardiovasc Med 2023; 10:1076093. [PMID: 36793476 PMCID: PMC9922860 DOI: 10.3389/fcvm.2023.1076093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023] Open
Abstract
Background Sepsis-induced myocardial dysfunction (SIMD) has a significant contribution to sepsis-caused death in critically ill patients. In recent years, the number of published articles related to SIMD has increased rapidly. However, there was no literature that systematically analyzed and evaluated these documents. Thus, we aimed to lay a foundation for researchers to quickly understand the research hotspots, evolution processes and development trends in the SIMD field via a bibliometric analysis. Methods Articles related to SIMD were retrieved and extracted from the Web of Science Core Collection on July 19th, 2022. CiteSpace (version 6.1.R2) and VOSviewer (version 1.6.18) were used for performing visual analysis. Results A total of 1,076 articles were included. The number of SIMD-related articles published each year has increased significantly. These publications mainly came from 56 countries, led by China and the USA, and 461 institutions, but without stable and close cooperation. As authors, Li Chuanfu published the most articles, while Rudiger Alain had the most co-citations. Shock was the journal with the most studies, and Critical Care Medicine was the most commonly cited journal. All keywords were grouped into six clusters, some of which represented the current and developing research directions of SIMD as the molecular mechanisms. Conclusion Research on SIMD is flourishing. It is necessary to strengthen cooperation and exchanges between countries and institutions. The molecular mechanisms of SIMD, especially oxidative stress and regulated cell death, will be critical subjects in the future.
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Affiliation(s)
- Hanyi Yao
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China,Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shufang Liu
- Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyu Zhang
- Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zixi Xiao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Dongping Li
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China,Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhangqing Yi
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China,Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuyang Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Haojie Zhou
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China,Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Weizhi Zhang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China,Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Weizhi Zhang,
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Xie Q, Wang Y, Zou GL. Protective effects of lavender oil on sepsis-induced acute lung injury via regulation of the NF-κB pathway. PHARMACEUTICAL BIOLOGY 2022; 60:968-978. [PMID: 35588105 PMCID: PMC9122384 DOI: 10.1080/13880209.2022.2067570] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
CONTEXT Lavender oil (Lav) from Lavandula angustifolia L. (Lamiacease) exhibits antioxidative and anti-inflammatory properties against various diseases. OBJECTIVE The study explores the effect of Lav pre-treatment on sepsis-induced acute lung injury (ALI). MATERIALS AND METHODS Sprague-Dawley rats were assigned into Sham, caecal ligation and puncture (CLP), CLP + Lav (200, 400, and 800 mg/kg) groups. Lav was administered by gavage, once a day, for 7 days. Histological analysis was performed using haematoxylin and eosin staining. Cytokine and nitrite levels were detected by enzyme-linked immunosorbent assay kits and Griess reagent. Gene and protein expression were tested by quantitative real-time polymerase chain reaction and western blot. RESULTS The levels of tumour necrosis factor-α (BALF: 64%, serum: 59%), interleukin (IL)-1β (BALF: 63%, serum: 66%) and IL-6 (BALF: 54%, serum: 59%), and nitrite (40%) and inducible nitric oxide synthase (51%), and the level of myeloperoxidase (66%) and malondialdehyde (59%), and cleaved-caspase 3 (84%) and Bax expression (74%) induced by CLP were decreased when given Lav. Additionally, the level of superoxide dismutase (211%) and glutathione (139%), and the expression of Bcl-2 (980%) induced by CLP were increased when given Lav. The increased p-nuclear factor (NF)-κB/NF-κB (72%) and p-inhibitor of κBα (IκBα)/IκBα (77%) induced by CLP could be reversed by Lav. DISCUSSION AND CONCLUSIONS Lav pre-treatment might protect rats from sepsis-induced ALI via deactivation of the NF-κB pathway. Our research demonstrated the regulatory mechanisms of Lav in sepsis-induced ALI and can provide a theoretical basis for the use of Lav in the treatment of sepsis-induced ALI.
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Affiliation(s)
- Qian Xie
- Pediatrics Department, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China
| | - Yi Wang
- Pediatrics Department, The Sanya Hongsen Hospital of Harbin Medical Universit, Sanya, Hainan, China
| | - Guo-Liang Zou
- No.1 Cardiovascular Disease Department, Heilongjiang Chinese Medical University No.1 Affiliated Hospital, Harbin, Heilongjiang, China
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Signaling Pathways in Inflammation and Cardiovascular Diseases: An Update of Therapeutic Strategies. IMMUNO 2022. [DOI: 10.3390/immuno2040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inflammatory processes represent a pivotal element in the development and complications of cardiovascular diseases (CVDs). Targeting these processes can lead to the alleviation of cardiomyocyte (CM) injury and the increase of reparative mechanisms. Loss of CMs from inflammation-associated cardiac diseases often results in heart failure (HF). Evidence of the crosstalk between nuclear factor-kappa B (NF-κB), Hippo, and mechanistic/mammalian target of rapamycin (mTOR) has been reported in manifold immune responses and cardiac pathologies. Since these signaling cascades regulate a broad array of biological tasks in diverse cell types, their misregulation is responsible for the pathogenesis of many cardiac and vascular disorders, including cardiomyopathies and atherosclerosis. In response to a myriad of proinflammatory cytokines, which induce reactive oxygen species (ROS) production, several molecular mechanisms are activated within the heart to inaugurate the structural remodeling of the organ. This review provides a global landscape of intricate protein–protein interaction (PPI) networks between key constituents of NF-κB, Hippo, and mTOR signaling pathways as quintessential targetable candidates for the therapy of cardiovascular and inflammation-related diseases.
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Jamal S, Ijaz SH, Minhas AMK, Kichloo A, Khan MZ, Albosta M, Aljadah M, Banga S, Baloch ZQ, Aboud H, Haji AQ, Sheikh A, Kanjwal K. Outcomes of Hospitalizations with Acute Respiratory Distress Syndrome with and without Atrial Fibrillation - Analyses from the National Inpatient Sample (2004-2014). Am J Med Sci 2022; 364:289-295. [DOI: 10.1016/j.amjms.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/17/2021] [Accepted: 01/31/2022] [Indexed: 11/01/2022]
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5
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Rashid M, Ramakrishnan M, Muthu DS, Chandran VP, Thunga G, Kunhikatta V, Shanbhag V, Acharya RV, Nair S. Factors affecting the outcomes in patients with acute respiratory distress syndrome in a tertiary care setting. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022; 13:100972. [PMID: 37309426 PMCID: PMC10250822 DOI: 10.1016/j.cegh.2022.100972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/27/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose The clinical profile and factors affecting outcomes in acute respiratory distress syndrome (ARDS) from adequately sample-sized Indian studies are still lacking. We aimed to investigate the clinical profile, treatment pattern, outcomes; and to assess factors affecting non-recovery in ARDS patients. Patients and methods A retrospective observational study was conducted among adult ARDS patients admitted during five year period (January 2014-December 2018) in a South Indian tertiary care setting. The relevant data were collected from the medical records to the data collection form. The univariate and multivariate logistic regression analyses were conducted to identify the predictors of outcomes using SPSS v20. Results A total of 857 participants including 496 males and 361 females with a mean age of 46.86 ± 15.81 years were included in this study. Fever (70.9%), crepitation (58.3%), breathlessness (56.9%), and cough (45%) were the major clinical presentation. Hypertension (25.2%), kidney disease (23.8%), and diabetes (22.3%) were the major comorbidities; and sepsis (37.6%), pneumonia (33.3%), and septic shock (27.5%) were the major etiological factors observed. Antibiotics and steroids were administered to 97.9% and 52.3% of the population, respectively. The recovery rate was 47.49%. The patients with scrub typhus, dengue, pancreatitis, and oxygen supplementation had significantly lower mortality. The factors such as advanced age, sepsis, septic shock, liver diseases, and ventilation requirements were observed to be the independent predictors of non-recovery in ARDS patients. Conclusion A comparable recovery rate was observed in our population. Advanced age, sepsis, septic shock, liver diseases, and ventilation requirements were the independent predictors of non-recovery.
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Affiliation(s)
- Muhammed Rashid
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Manasvini Ramakrishnan
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Deepa Sudalai Muthu
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Viji Pulikkel Chandran
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Vijayanarayana Kunhikatta
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Vishal Shanbhag
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Raviraja V Acharya
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Sreedharan Nair
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
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Editorial: Septic shock: what we should know… or almost! Curr Opin Anaesthesiol 2021; 34:69-70. [PMID: 33652453 DOI: 10.1097/aco.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Garcia-Montilla R, Mukundan S, Heitner SB, Khan A. Inferior vena cava dilation predicts global cardiac dysfunction in acute respiratory distress syndrome: A strain echocardiographic study. Echocardiography 2021; 38:238-248. [PMID: 33428265 DOI: 10.1111/echo.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/30/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Limited data exist on the utility of ultrasonographic evaluation of inferior vena cava (IVC) in acute respiratory distress syndrome (ARDS). We studied the value of IVC diameter in assessing cardio-circulatory performance in ARDS using strain echocardiography. MATERIALS AND METHODS Retrospective cross-sectional analysis of Doppler echocardiograms of patients with moderate-severe ARDS was performed. Right ventricle (RV) parameters, IVC diameter, and left ventricle (LV) systolic and diastolic parameters were collected. RV free wall strain (RVFWS) and LV global longitudinal strain (LVGLS) were calculated. RESULTS Fifty-one patients were dichotomized into two groups: with IVC > 2.1 cm (dilated) and with IVC ≤ 2.1 cm (nondilated). The dilated IVC group presented worse hypoxemic profile, hypotension, and poor perfusion markers. No significant associations with positive end-expiratory pressure or lung mechanics were observed. Dilated IVC was associated with impaired RV function, high central venous pressure, elevated pulmonary artery pressure, and LV systolic and diastolic dysfunctions. Strongest predictors of a dilated IVC were RVFWS, LVGLS, and tissue Doppler mitral annular early diastolic velocity. Dilated IVC predicted a global cardiac dysfunction defined by strain echocardiography (GCDS) with high sensitivity and specificity. CONCLUSIONS In ARDS, strain echocardiography analyses demonstrated that a dilated IVC is associated with GCDS and impaired hemodynamics independent of lung mechanics. A dilated IVC should be considered a marker of circulatory distress, signaling the potential necessity for improved hemodynamic optimization.
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Affiliation(s)
- Romel Garcia-Montilla
- Department of Trauma Surgery and Surgical Critical Care, Marshfield Medical Center, Marshfield, WI, USA.,Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA.,Knight Cardiovascular Institute, Clinical Echocardiography, Oregon Health and Science University, Portland, OR, USA
| | - Srini Mukundan
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Stephen B Heitner
- Knight Cardiovascular Institute, Clinical Echocardiography, Oregon Health and Science University, Portland, OR, USA
| | - Akram Khan
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
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8
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Pan P, Su L, Liu D, Wang X. Microcirculation-guided protection strategy in hemodynamic therapy. Clin Hemorheol Microcirc 2020; 75:243-253. [PMID: 31903987 DOI: 10.3233/ch-190784] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Microcirculatory shock is a condition defined by the presence of tissue hypoperfusion despite the normalization of systemic and regional blood flow. Currently, more evidence shows that intrinsic septic shock is microcirculatory shock, which results in septic shock that is difficult to resuscitate. At present, treatments are aimed at recovering macro-circulation functions and include fluid resuscitation, vasoactive drugs, positive inotropic drugs, de-obstruction, and even mechanical assistance to improve oxygen delivery. However, the application of these treatments to more accurately improve microcirculation or avoid further microcirculatory damage is more important in clinics. In this article, we discuss the need for microcirculation protection and microcirculation-guided protection strategies in hemodynamic therapies.
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Affiliation(s)
- Pan Pan
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.,Center of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Longxiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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9
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Liu S, She F, Zhang W, Hu X, Zhao X, Yao Y. Tryptophan decreases the intensity of lipopolysaccharide-induced acute lung injury in a rat model. Amino Acids 2020; 52:1139-1147. [PMID: 32789611 DOI: 10.1007/s00726-020-02878-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
Sepsis is a severe clinical condition that is a result of the cellular and biochemical response to infection. The present study evaluated the therapeutic potential of tryptophan against lipopolysaccharide (LPS)-induced acute lung injury (ALI) in rats. Rats were grouped into sham, control (ALI), and ALI + 1, 25, and 50 mg/kg body weight L-tryptophan. Supplementation with 1, 25, and 50 mg/kg L-tryptophan reduced the total protein content by 4.9%, 33.4%, and 64.5%; the levels of neutrophils (12.5%, 31.8%, and 65.1%), lymphocytes (15.1%, 41.7%, and 63.3%), total cells (12.6%, 42.4%, and 65.7%); lipid peroxidation (9.4%, 28.4%, and 68.7%); myeloperoxidase levels (12.1%, 33.4%, and 68.2%); migration inhibitory factor (12.7%, 39.5%, and 68.2%), interleukin (IL)-8 (5.5%, 46.8%, and 78.5%), tumor necrosis factor (TNF)-α (10.8%, 39.8%, and 72.2%), respectively. Supplementation with 1, 25, and 50 mg/kg L-tryptophan reduced mRNA expression of TNF-α (4.5%, 21.8%, and 41.8%), IL-1β (5.2%, 17.9%, and 46.2%); and the protein expression of TNF-α (2.8%, 15.2%, and 35.7%) and IL-1β (5.2%, 15.6%, and 28.6%), respectively. It also reduced glutathione (to near normal levels), neutrophilic infiltration and edema, and the wet/dry ratio of lung tissue. It significantly increased catalase, superoxide dismutase, glutathione peroxidase levels, as well as the partial pressure of oxygen (PaO2) by 21.9%, 52.8%, and 87.4%, respectively. Altogether, our results suggest that supplementation with L-tryptophan has a strong protective effect against LPS-induced ALI.
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Affiliation(s)
- Shuangqing Liu
- Medical school of Chinese PLA, Beijing, China.,Department of Emergency, the Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China.,Trauma Research Center, the Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Fei She
- Department of Emergency, the Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Wei Zhang
- Department of Emergency, the Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Xia Hu
- Department of Emergency, the Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Xiaodong Zhao
- Department of Emergency, the Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Yongming Yao
- Medical school of Chinese PLA, Beijing, China. .,Trauma Research Center, the Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China.
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Myocardial Function during Low versus Intermediate Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome. Anesthesiology 2020; 132:1102-1113. [PMID: 32053557 DOI: 10.1097/aln.0000000000003175] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mechanical ventilation with low tidal volumes has the potential to mitigate ventilation-induced lung injury, yet the clinical effect of tidal volume size on myocardial function has not been clarified. This cross-sectional study investigated whether low tidal volume ventilation has beneficial effects on myocardial systolic and diastolic function compared to intermediate tidal volume ventilation. METHODS Forty-two mechanically ventilated patients without acute respiratory distress syndrome (ARDS) underwent transthoracic echocardiography after more than 24 h of mechanical ventilation according to the Protective Ventilation in Patients without ARDS (PReVENT) trial comparing a low versus intermediate tidal volume strategy. The primary outcome was left ventricular and right ventricular myocardial performance index as measure for combined systolic and diastolic function, with lower values indicating better myocardial function and a right ventricular myocardial performance index greater than 0.54 regarded as the abnormality threshold. Secondary outcomes included specific systolic and diastolic parameters. RESULTS One patient was excluded due to insufficient acoustic windows, leaving 21 patients receiving low tidal volumes with a tidal volume size (mean ± SD) of 6.5 ± 1.8 ml/kg predicted body weight, while 20 patients were subjected to intermediate tidal volumes receiving a tidal volume size of 9.5 ± 1.6 ml/kg predicted body weight (mean difference, -3.0 ml/kg; 95% CI, -4.1 to -2.0; P < 0.001). Right ventricular dysfunction was reduced in the low tidal volume group compared to the intermediate tidal volume group (myocardial performance index, 0.41 ± 0.13 vs. 0.64 ± 0.15; mean difference, -0.23; 95% CI, -0.32 to -0.14; P < 0.001) as was left ventricular dysfunction (myocardial performance index, 0.50 ± 0.17 vs. 0.63 ± 0.19; mean difference, -0.13; 95% CI, -0.24 to -0.01; P = 0.030). Similarly, most systolic parameters were superior in the low tidal volume group compared to the intermediate tidal volume group, yet diastolic parameters did not differ between both groups. CONCLUSIONS In patients without ARDS, intermediate tidal volume ventilation decreased left ventricular and right ventricular systolic function compared to low tidal volume ventilation, although without an effect on diastolic function.
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11
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Jones TW, Smith SE, Van Tuyl JS, Newsome AS. Sepsis With Preexisting Heart Failure: Management of Confounding Clinical Features. J Intensive Care Med 2020; 36:989-1012. [PMID: 32495686 DOI: 10.1177/0885066620928299] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Preexisting heart failure (HF) in patients with sepsis is associated with worse clinical outcomes. Core sepsis management includes aggressive volume resuscitation followed by vasopressors (and potentially inotropes) if fluid is inadequate to restore perfusion; however, large fluid boluses and vasoactive agents are concerning amid the cardiac dysfunction of HF. This review summarizes evidence regarding the influence of HF on sepsis clinical outcomes, pathophysiologic concerns, resuscitation targets, hemodynamic interventions, and adjunct management (ie, antiarrhythmics, positive pressure ventilatory support, and renal replacement therapy) in patients with sepsis and preexisting HF. Patients with sepsis and preexisting HF receive less fluid during resuscitation; however, evidence suggests traditional fluid resuscitation targets do not increase the risk of adverse events in HF patients with sepsis and likely improve outcomes. Norepinephrine remains the most well-supported vasopressor for patients with sepsis with preexisting HF, while dopamine may induce more cardiac adverse events. Dobutamine should be used cautiously given its generally detrimental effects but may have an application when combined with norepinephrine in patients with low cardiac output. Management of chronic HF medications warrants careful consideration for continuation or discontinuation upon development of sepsis, and β-blockers may be appropriate to continue in the absence of acute hemodynamic decompensation. Optimal management of atrial fibrillation may include β-blockers after acute hemodynamic stabilization as they have also shown independent benefits in sepsis. Positive pressure ventilatory support and renal replacement must be carefully monitored for effects on cardiac function when HF is present.
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Affiliation(s)
- Timothy W Jones
- Department of Clinical and Administrative Pharmacy, 15506University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Susan E Smith
- Department of Clinical and Administrative Pharmacy, 15506University of Georgia College of Pharmacy, Athens, GA, USA
| | - Joseph S Van Tuyl
- Department of Pharmacy Practice, 14408St Louis College of Pharmacy, St Louis, MO, USA
| | - Andrea Sikora Newsome
- Department of Clinical and Administrative Pharmacy, 15506University of Georgia College of Pharmacy, Augusta, GA, USA.,Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
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L–lysine ameliorates sepsis-induced acute lung injury in a lipopolysaccharide-induced mouse model. Biomed Pharmacother 2019; 118:109307. [DOI: 10.1016/j.biopha.2019.109307] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 01/19/2023] Open
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13
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Narváez I, Canabal A, Martín C, Sánchez M, Moron A, Alcalá J, Giacoman S, Magro M. Incidence and evolution of sepsis-induced cardiomyopathy in a cohort of patients with sepsis and septic shock. Med Intensiva 2017; 42:283-291. [PMID: 29100618 DOI: 10.1016/j.medin.2017.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/11/2017] [Accepted: 08/26/2017] [Indexed: 12/13/2022]
Abstract
OBJETIVE The aim of this study was to establish the incidence of septic cardiomyopathy (SM) in patients with sepsis and septic shock, to describe its characteristics and testing its evolution. DESIGN Prospective cohort study. PARTICIPANTS We included 57 consecutive patients admitted to Intensive Care Unit, who met criteria of sepsis and septic shock. PRINCIPAL VARIABLES OF INTEREST Clinical and biochemical variables were analyzed. An echocardiogram was performed in the first 24hours of admission, determining myocardial function parameters, and if the patients had left ventricular ejection fraction (LVEF)<50%) a second echocardiogram was performed. AMBIT Intensive medical and surgical Care Service for Adults in University Hospital. RESULTS The mean age of the patients was 62,1±16,3 years. 58% were males. 22.8% had left ventricular dysfunction. The mean LVEF in patients with MS was lower than those without SM (34.1±10.6 vs 60.7±6.94%, P<.001), with complete recovery, in survivors, after the acute event (LVEF at discharge 56.1±6.3%, P=.04). Patients with SM had higher levels of procalcitonin (47.1±35.4 vs 18.9±24.5; P=.02) and higher score on the Sequential Organ Failure Assessment (SOFA score) (9.91±3.82 vs 7.47±3.41; P=.037). Mortality was not significantly different between both groups [4 (30.8%) vs 4 (9.1%); P=.07]. CONCLUSIONS SM is not uncommon and is related to a higher scores on the severity scales. In the survivors, LVEF normalized after the recovery of the acute event.
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Affiliation(s)
- I Narváez
- Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, España.
| | - A Canabal
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
| | - C Martín
- Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, España
| | - M Sánchez
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
| | - A Moron
- Universidad de Castilla La Mancha, Ciudad Real, España
| | - J Alcalá
- Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, España
| | - S Giacoman
- Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, España
| | - M Magro
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
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Haemodynamic Effects of Lung Recruitment Manoeuvres. BIOMED RESEARCH INTERNATIONAL 2015; 2015:478970. [PMID: 26682219 PMCID: PMC4670625 DOI: 10.1155/2015/478970] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/29/2015] [Accepted: 10/12/2015] [Indexed: 01/11/2023]
Abstract
Atelectasis caused by lung injury leads to increased intrapulmonary shunt, venous admixture, and hypoxaemia. Lung recruitment manoeuvres aim to quickly reverse this scenario by applying increased airway pressures for a short period of time which meant to open the collapsed alveoli. Although the procedure can improve oxygenation, but due to the heart-lung and right and left ventricle interactions elevated intrathoracic pressures can inflict serious effects on the cardiovascular system. The purpose of this paper is to give an overview on the pathophysiological background of the heart-lung interactions and the best way to monitor these changes during lung recruitment.
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Left ventricular global longitudinal strain is independently associated with mortality in septic shock patients. Intensive Care Med 2015; 41:1791-9. [PMID: 26183489 DOI: 10.1007/s00134-015-3970-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Conventional echocardiography may not detect subtle cardiac dysfunction of septic patients. Two-dimensional left ventricular (LV) global peak systolic longitudinal strain (GLS) can detect early cardiac dysfunction. We sought to determine the prognostic value of GLS for septic shock patients admitted to intensive care units (ICUs). METHODS We prospectively included 111 ICU patients with septic shock. A full medical history was recorded for each patient, and LV systolic function, including GLS, was measured. Our endpoints were ICU and hospital mortality. RESULTS The ICU and hospital mortalities were 31.5% (n = 35) and 35.1% (n = 39), respectively. There was no significant difference in LV ejection fraction of the non-survivors and the survivors; however, upon ICU admission, the non-survivors exhibited GLSs that were less negative than those of the survivors, which indicated worse LV systolic function. GLS of -13% presented the best sensitivity and specificity in the prediction of mortality (area under the curve 0.79). The patients with GLS ≥ -13% exhibited higher ICU and hospital mortality rates (hazard ratio 4.34, p < 0.001 and hazard ratio 4.21, p < 0.001, respectively). Cox regression analyses revealed that higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores and less negative GLSs were independent predictors of ICU and hospital mortalities. GLS was found to add prognostic information to the APACHE II score. CONCLUSIONS These findings suggest that combining GLS and the APACHE II score has additive value in the prediction of ICU and hospital mortalities and that GLS may help in early identification of high-risk septic shock patients in ICU.
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