tailieunhanh - Báo cáo y học: " Vasopressor stays vasopressor and inotrope stays inotrope"

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: Vasopressor stays vasopressor and inotrope stays inotrope! | Available online http content 12 2 415 Letter Vasopressor stays vasopressor and inotrope stays inotrope Gunter Luckner1 Walter R Hasibeder2 and Martin W Dunser1 1 Department of Anesthesiology and Critical Care Medicine Innsbruck Medical University Anichstrasse 6020 Innsbruck Austria 2Department of Anesthesiology and Critical Care Medicine Krankenhaus der Barmherzigen Schwestern Ried im Innkreis Austria Corresponding author Martin W Dunser Published 14 April 2008 This article is online at http content 12 2 415 2008 BioMed Central Ltd Critical Care 2008 12 415 doi cc6850 See related research by Muller et al. http content 12 1 R20 We should like to comment on the interesting work reported by Muller and colleagues 1 . We feel that the results of their experiment were predictable and that arginine vasopressin AVP was not indicated in that setting. Infusing a vasoconstrictor without relevant inotropic potential in an acute low flow state with maintained or increased vascular tone must further augment organ vascular resistance and thereby reduce cardiac output. In the critical care setting a vasopressor can only be beneficial in patients with pathological vasodilatation whereas patients with low systemic blood flow and maintained vascular tone require either fluids and or an inotrope. In their report Muller and colleagues indiscriminately interchange vasodilatory and cardiogenic shock. However these forms of shock must be strictly separated when considering the use of a strong vasopressor such as AVP. Some patients with cardiogenic shock will subsequently develop an additional vasodilatory component 2 . Although they require an inotrope at early stages a vasopressor may be useful to restore a sub normal vascular tone at later stages. We therefore believe that this experiment does not appropriately reflect the clinical situation and does not support the conclusion that AVP as a rule should not be .

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