Shock Distributive Publications (150)


Shock Distributive Publications

Chin. Med. Sci. J.
Chin Med Sci J 2016 Mar;31(1):37-42
Department of Critical Care Medicine, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, 100021 Beijing, China.

Objective To investigate the respiratory and cardiac characteristics of elderly Intensive Care Unit (ICU) patients.Methods Twelve senior ICU patients aged 90 years and older were enrolled in this study. We retrospectively collected all patients' clinical data through medical record review. Read More

The basic demographics, primary cause for admission, the condition of respiratory and circulatory support, as well as prognosis were recorded. Shock patients and pneumonia patients were specifically analyzed in terms of clinical manifestations, laboratory variables, echocardiography, and lung ultrasound Results.Results The mean age of the included patients was 95 years with a male predominance (8 to 4, 66.7%). Regarding the reasons for admission, 6 (50.0%) patients had respiratory failure, 1 (8.3%) patient had shock, while 5 (41.7%) patients had both respiratory failure and shock. Of the 6 patients who suffered from shock, only 1 was diagnosed with distributive shock, 5 with cardiogenic shock. Of the 5 cardiogenic shock patients, 1 was diagnosed with acute coronary syndrome. The rest 4 cardiogenic shock patients were diagnosed with Takotsubo cardiomyopathy. The patient with ST-segment elevation myocardial infarction died within 24 hours. Of the 4 Takotsubo patients, 1 died on day-6 and the other 3 patients were transferred to ward after heart function recovered in 1 to 2 weeks. Of the 10 pneumonia patients, 3 were diagnosed as community acquired pneumonia, and 7 as hospital acquired pneumonia. Only 3 patients were successfully weaned from ventilator. The others required long-term ventilation complicated with heart failure, mostly with diastolic heart failure. Lung ultrasound of 6 patients with diastolic dysfunction showed bilateral B-lines during spontaneous breathing trial.Conclusions Elderly patients in shock tend to develop Takotsubo cardiomyopathy. Diastolic heart dysfunction might be a major contributor to difficult weaning from ventilator in elderly patients. Bedside lung ultrasonography and echocardiography could help decide the actual cause of respiratory failure and shock more accurately and effectively.

Shock 2016 Dec 14. Epub 2016 Dec 14.
*Department of Emergency Medicine, Odense University Hospital, Denmark †Department of Respiratory Medicine, Odense University Hospital, Denmark ‡Centre for Individualized Medicine in Arterial Diseases (CIMA) Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark §Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Denmark ¶Department of Infectious Diseases, Odense University Hospital, Denmark.

The knowledge of the etiology and associated mortality of undifferentiated shock in the emergency department (ED) is limited. We aimed to describe the etiology based proportions and incidence rates (IR) of shock, as well as the associated mortality in the ED.
Population-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. Read More

Patients aged ≥18 years living in the ED-catchment area (N = 225,000) with a first time ED presentation with shock (n = 1,646) defined as hypotension (systolic blood pressure ≤100 mmHg)) and ≥1 organ failures were included. Discharge diagnoses defined the etiology and were grouped as; distributive septic shock (SS), distributive non-septic shock (NS)), cardiogenic shock (CS), hypovolemic shock (HS), obstructive shock (OS) and other conditions (OC). Outcomes were etiology-based characteristics, annual IR per 100,000 person-years at risk (95% CIs), mortality at 0-7-, and 0-90 days (95% CIs) and hazard rates (HR) at 0-7, 8-90 days (95% CIs). Poisson and Cox regression models were used for analyses.
Among 1,646 shock patients: 434 (26.4%) had SS, 384 (23.3%) NS, 237 (14.4%) CS, 515 (31.3%) HS, 15 (0.9%) OS and 61 (3.7%) OC. The corresponding IR's were: 16.7/100,000 (11.7-23.6), 14.7/100,000 (12.7-17.1), 9.1/100,000 (6.5-12.8), 19.8/100,000 (15.0-26.0), 0.6/100,000 (0.3-10.5) and 2.3/100,000 (1.8-3.0). SS IR increased from 8.9-28.5/100,000 during the period 2000-2011. Accordingly, the 7-, and 90-day mortalities of SS, NS, CS, and HS were: 28.9% (95% CI: 24.3-34.1) and 53.4% (95% CI: 48.0-58.8), 12.1% (95% CI: 8.8-16.4) and 23.3% (95% CI: 18.8-28.6), 32.0% (95% CI: 25.5-39.2) and 50.2% (95% CI: 42.8-57.6), 20.4% (95% CI: 16.6-24.7) and 37.6% (95% CI: 32.8-42.5). SS (HR = 1.56 (95% CI, 1.11-2.20)), and CS (HR = 2.03 (95% CI, 1.40-2.93)) were independent predictors of death within 0-7 days, whereas SS was a predictor within 8-90 days (HR = 1.71 (95% CI: 1.19-2.46)).
HS and SS are frequent etiological characteristics followed by NS and CS, whereas OS is a rare condition. We confirm the increasing trend of SS, as previously reported. 7-day mortality ranged from 12% to 32% while 90-day mortality ranged from 23% to 54%. The underlying etiology was an independent predictor of mortality.

Best Pract Res Clin Anaesthesiol
Best Pract Res Clin Anaesthesiol 2016 Dec 5;30(4):465-477. Epub 2016 Nov 5.
Department of Anaesthesiology, University Hospital of Greifswald, Greifswald, Germany. Electronic address:

The present review initially describes the rationale for the use of non-adrenergic vasopressors in the treatment of distributive shock and then provides an overview of the individual vasopressin-receptor agonists, namely arginine vasopressin, terlipressin, and selepressin. Following a brief summary of their current use in clinical practice, the present review focuses on the influence of vasopressin-receptor agonists on macro- and microvascular coupling, also referred to as hemodynamic coherence. On the basis of the current evidence from experimental and clinical studies, vasopressin-receptor agonists do not negatively influence macro- and microvascular coupling as compared to the standard therapy with norepinephrine, when used in established treatment regimes. Read More

A higher selectivity for the V1a-receptor seems to be beneficial; however, future clinical trials are warranted to verify this assumption. Notably, the optimal treatment regime for non-adrenergic vasopressors with respect to compound, dose, and timing still needs to be defined.

A A Case Rep
A A Case Rep 2016 Nov 28. Epub 2016 Nov 28.
From the *Division of Anesthesiology, Antonio Pedro University Hospital, Fluminense Federal University, Niterói, Brazil; and †Department of Surgery, Fluminense Federal University Medical School, Niterói, Brazil.

Mesenteric traction syndrome is defined as arterial hypotension, facial flushing, and tachycardia related to mesenteric traction. We describe a case of mesenteric traction syndrome refractory to catecholamine and vasopressin infusions. The patient, who had Crohn disease, developed severe distributive shock after mesenteric traction while undergoing resection of an intestinal inflammatory mass, accompanied by facial flushing and unaltered readings for pulse oximetry, capnography, and bispectral index monitoring. Read More

The absence of tachycardia in this case was attributed to long-term use of timolol. Arterial pressure returned to baseline level after approximately 30 minutes, and the postoperative period was uneventful.

Expert Rev Anti Infect Ther
Expert Rev Anti Infect Ther 2017 Jan 7;15(1):5-10. Epub 2016 Nov 7.
b Service d'Anesthésie et de Réanimation , Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université , Marseille , France.
Paediatr Drugs
Paediatr Drugs 2016 Oct 20. Epub 2016 Oct 20.
Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany.

Data are still lacking about the use of terlipressin or vasopressin in the treatment of pediatric patients who are in a state of therapy-refractory shock.
The aim of this study was to evaluate the effect of terlipressin on hemodynamics in children with distributive shock and to describe any severe side effects.
Consecutive patients (n = 20) with catecholamine-resistant distributive shock who were treated with terlipressin were retrospectively enrolled in this study. Read More

We analyzed response in terms of mean arterial blood pressure, heart rate, vasoactive inotropic score (VIS), urinary output, and serum lactate.
The hemodynamics of 12 children significantly improved within 6 h of commencing terlipressin (mean blood pressure increase of ≥20 % without VIS increase, or mean blood pressure increase of ≥10 % with VIS decrease of ≥10 %). The hemodynamics of eight patients did not improve, regardless of treatment dosage or duration. More children died in the responders group (n = 7 [58.3 %]) than in the non-responders group (n = 2 [25.0 %]), but this was not statistically significant. Two patients (one in each group) who received high dosages of terlipressin developed rhabdomyolysis. One case of Takotsubo cardiomyopathy was observed, which could be related to terlipressin.
Although treatment with terlipressin resulted in rapid positive hemodynamic responses in some children, it did not seem to have a positive effect in other pediatric patients. Therefore, the possible benefits of terlipressin should be always weighed against potential severe adverse effects.

Zhonghua Nei Ke Za Zhi
Zhonghua Nei Ke Za Zhi 2016 Sep;55(9):741-4
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China.
Kidney Dis (Basel)
Kidney Dis (Basel) 2016 Jun 18;2(2):64-71. Epub 2016 May 18.
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minn., USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn., USA.

Intravenous fluids (IVF) are frequently utilized to restore intravascular volume in patients with distributive and hypovolemic shock. Although the benefits of the appropriate use of fluids in intensive care units (ICUs) and hospitals are well described, there is growing knowledge regarding the potential risks of volume overload and its impact on organ failure and mortality. To avoid volume overload and its associated complications, strategies to identify fluid responsiveness are developed and utilized more often among ICU patients. Read More

Apart from the amount of fluid utilized for resuscitation, the type of fluid used also impacts patient outcome. Colloids and crystalloids are two types of fluids that are utilized for resuscitation. The efficacy of each fluid type on the expansion of intravascular volume on one hand and the potential adverse effects of each individual fluid, on the other hand, need to be considered when choosing the type of fluid for resuscitation. The negative impact of hydroxyethyl starch on kidney function, of albumin on the mortality of head trauma patients and chloride-rich crystalloids on mortality and kidney function, are only examples of new developments in the field.
In this paper, we will review the impact of fluid overload on patient outcomes, define the fluid challenge, describe the differences in static and dynamic estimates of fluid responsiveness, and review the effect of different types of fluid on patient outcome.
Avoiding fluid overload by choosing the appropriate amount of fluids in patients who are fluid-responsive on one hand, and treating IVF like other medications, on the other hand, are the major changes. Whenever clinicians decide to prescribe IVF, they need to weigh the risks and benefits of giving fluid and also the advantages and side effects of each fluid type in order to optimize patient outcomes.

Med Klin Intensivmed Notfmed
Med Klin Intensivmed Notfmed 2016 Oct 17;111(7):590-595. Epub 2016 Jun 17.
Medizinische Klinik I, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.

In caring for critically ill patients, a sophisticated approach to treating hemodynamic instability in acute circulatory failure is a major concern of modern critical care. Depending on the form of shock-distributive, cardiogenic, hypovolemic or obstructive, with the possibility of overlapping forms of shock-preload, afterload, cardiac output, and contractility are altered in various ways. Modern critical care uses hemodynamic monitoring and bedside echocardiography in addition to clinical evaluation to treat the underlying cause and sequelae of shock. Read More

Fluid therapy taking volume responsiveness and need for volume into account, vasopressor therapy taking microcirculatory derangement into account, and therapy using inotropes, sometimes in combination with vasodilators are the cornerstones of critical care treatment in this regard. Preload, afterload, cardiac output, and contractility must thereby be evaluated and treated in a patient- and situation-specific manner.

Crit Care
Crit Care 2016 May 27;20(1):137. Epub 2016 May 27.
Department of Intensive Care Medicine, Prince Sultan Military City, Kingdom of Saudi Arabia.