tailieunhanh - Báo cáo khoa học: "Bench-to-bedside review: Is there a place for epinephrine in septic shock"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Bench-to-bedside review: Is there a place for epinephrine in septic shock? | Available online http content 9 6 561 Review Bench-to-bedside review Is there a place for epinephrine in septic shock Bruno Levy Service de Réanimation Médicale Hôpital Central 54000 Nancy France Corresponding author Bruno Levy Published online 4 November 2005 This article is online at http content 9 6 561 2005 BioMed Central Ltd Critical Care 2005 9 561-565 DOI cc3901 Abstract The use of epinephrine in septic shock remains controversial. Nevertheless epinephrine is widely used around the world and the reported morbidity and mortality rates with it are no different from those observed with other vasopressors. In volunteers epinephrine increases heart rate mean arterial pressure and cardiac output. Epinephrine also induces hyperglycemia and hyperlactatemia. In hyperkinetic septic shock epinephrine consistently increases arterial pressure and cardiac output in a dose dependent manner. Epinephrine transiently increases lactate levels through an increase in aerobic glycolysis. Epinephrine has no effect on splanchnic circulation in dopamine-sensitive septic shock. On the other hand in dopamine-resistant septic shock epinephrine has no effect on tonometric parameters but decreases fractional splanchnic blood flow with an increase in the gradient of mixed venous oxygen saturation SVO2 and hepatic venous oxygen saturation SHO2 . In conclusion epinephrine has predictable effects on systemic hemodynamics and is as efficient as norepinephrine in correcting hemodynamic disturbances of septic shock. Moreover epinephrine is cheaper than other commonly used catecholamine regimens in septic shock. The clinical impact of the transient hyperlactatemia and of the splanchnic effects are not established. Introduction Early goal directed therapy 1 is now considered as a gold standard in the early phase of septic shock. Fluid therapy and vasoactive therapy may be immediately required in order to maintain acceptable blood pressure .

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