Pharmacological and Mechanical cardiac Support in Intensive Care Unit
Ahmed Lotfy Elsayed Elmorally;
Abstract
Shock is a state of inadequate perfusion where oxygen delivery to the tissues fails to meet oxygen demands. A shock state might emerge from a reduction in oxygen tissue delivery (VO2), or from an increase in oxygen demands (DO2).
The four types of shock included are (A) hypovolemic, (B) cardiogenic, (C) obstructive, (D) distributive.
Cardiogenic shock is a physiologic state in which inadequate tissue perfusion result from cardiac dysfunction, occuring most commonly following acute myocardial infarction. So initiation of inotropic and/or vasopressor drug therapy may be necessary.
Manifestations of shock include signs of peripheral hypoperfusion such as oliguria, systemic hypotension and decreased CO with elevated PAOP although physical examination reveals findings of volume overload, including pulmonary and peripheral edema, and hepatomegaly.
Management of the shocked patient includes oxygen therapy, mechanical ventilation, fluid therapy and inotropic support.
Conventional inotropic agents seem to be useful in restoring hemodynamic parameters and improving peripheral organ perfusion but can increase short and long-term morbidity and mortality in these patients.
The basis of the acute inotropic response to an increased adrenergic drive is the rapid increase in the tissue levels of the second messenger, cyclic AMP. Inotropic agents inculde dopamine, dobutamine, epinephrine, norepinephrine, isoprenline, ephedrine, phenylephrine, vasopressin, milrinone, levosimendan.
Epinephrine is a mainstay of resuscitation therapy during cardiopulmonary arrest. Also, it is the drug of choice for anaphylaxis as it decreases mediator release from mast cells.
The four types of shock included are (A) hypovolemic, (B) cardiogenic, (C) obstructive, (D) distributive.
Cardiogenic shock is a physiologic state in which inadequate tissue perfusion result from cardiac dysfunction, occuring most commonly following acute myocardial infarction. So initiation of inotropic and/or vasopressor drug therapy may be necessary.
Manifestations of shock include signs of peripheral hypoperfusion such as oliguria, systemic hypotension and decreased CO with elevated PAOP although physical examination reveals findings of volume overload, including pulmonary and peripheral edema, and hepatomegaly.
Management of the shocked patient includes oxygen therapy, mechanical ventilation, fluid therapy and inotropic support.
Conventional inotropic agents seem to be useful in restoring hemodynamic parameters and improving peripheral organ perfusion but can increase short and long-term morbidity and mortality in these patients.
The basis of the acute inotropic response to an increased adrenergic drive is the rapid increase in the tissue levels of the second messenger, cyclic AMP. Inotropic agents inculde dopamine, dobutamine, epinephrine, norepinephrine, isoprenline, ephedrine, phenylephrine, vasopressin, milrinone, levosimendan.
Epinephrine is a mainstay of resuscitation therapy during cardiopulmonary arrest. Also, it is the drug of choice for anaphylaxis as it decreases mediator release from mast cells.
Other data
| Title | Pharmacological and Mechanical cardiac Support in Intensive Care Unit | Other Titles | لدعم الدوائي والميكانيكي للقلب بوحدة الرعاية المركزة | Authors | Ahmed Lotfy Elsayed Elmorally | Issue Date | 2014 |
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