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    154 results match your criteria Shock Distributive

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    An Ovine Model of Hyperdynamic Endotoxemia and Vital Organ Metabolism.
    Shock 2017 May 17. Epub 2017 May 17.
    *The Critical Care Research Group, Chermside, Brisbane, Australia †Australian National University, Canberra, ACT, Australia ‡The Canberra Hospital Yamba Dr, Garran, ACT, Australia §Queensland University of Technology, Brisbane City, Australia ||University of Queensland, St Lucia, Australia ¶QIMR Berghofer Medical Research Institute, Herston, Brisbane, Australia **Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Australia ††The Emergency Department Royal Brisbane Women and Children's Hospital Brisbane, Australia ‡‡The Adult Intensive Care, The Prince Charles Hospital, Chermside, Brisbane, Australia §§Department of Paediatrics, Faculty of Medicine, Imperial College London, United Kingdom.
    Background: Animal models of endotoxemia are frequently used to understand the pathophysiology of sepsis and test new therapies. However, important differences exist between commonly used experimental models of endotoxemia and clinical sepsis. Animal models of endotoxemia frequently produce hypodynamic shock in contrast to clinical hyperdynamic shock. Read More

    Coronary spasm secondary to cefuroxime injection, complicated with cardiogenic shock - a manifestation of Kounis syndrome: case report and literature review.
    Eur Heart J Acute Cardiovasc Care 2017 Mar 1:2048872617701885. Epub 2017 Mar 1.
    3 Intensive Care Unit, Nicosia General Hospital, Cyprus.
    Kounis syndrome is defined as the coincidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergic event. The three reported variants of Kounis syndrome are vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus. The syndrome is caused by various inflammatory mediators. Read More

    Augmenting Function for Infarction from Infection: Impella 2.5 for Ischemic Cardiogenic Shock Complicating Sepsis.
    Case Rep Cardiol 2017 5;2017:8407530. Epub 2017 Feb 5.
    Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
    Cardiac dysfunction is a common complication of sepsis in individuals with preexisting coronary disease and portends a poor prognosis when progressing to ischemic cardiogenic shock. In this setting, maximal medical therapy in isolation is often inadequate to maintain cardiac output for patients who are poor candidates for immediate revascularization. Furthermore, the use of vasopressors and inotropes increases myocardial demand and may lead to further injury. Read More

    Distributive Shock in the Emergency Department: Sepsis, Anaphylaxis, or Capillary Leak Syndrome?
    J Emerg Med 2017 Feb 18. Epub 2017 Feb 18.
    Department of Emergency Medicine, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey.
    Background: Distributive shock is a hyperdynamic process resulting from excessive vasodilatation. Impaired blood flow causes inadequate tissue perfusion, which can lead to end-organ damage. Although the most common etiology is septic shock, anaphylactic and other etiologies should be considered. Read More

    Respiratory and Cardiac Characteristics of ICU Patients Aged 90 Years and Older: A Report of 12 Cases.
    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

    Etiology of Shock in the Emergency Department; A 12 Year Population Based Cohort Study.
    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.
    Introduction: 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.

    Methods: Population-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. Read More

    Effect of non-adrenergic vasopressors on macro- and microvascular coupling in distributive shock.
    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

    Severe Intraoperative Shock Related to Mesenteric Traction Syndrome.
    A A Case Rep 2017 Feb;8(3):51-54
    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

    Optimum treatment of vasopressor-dependent distributive shock.
    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.
    Introduction: Distributive shock is associated with decreased systemic vascular resistance and altered oxygen extraction. Septic shock is the most frequent form of distributive shock. In shock states, duration of hypotension is associated with poor outcomes. Read More

    Safety and Efficacy of Terlipressin in Pediatric Distributive Shock: A Retrospective Analysis in 20 Children.
    Paediatr Drugs 2017 Feb;19(1):35-41
    Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany.
    Introduction: 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.

    Objective: 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.

    Methods: Consecutive patients (n = 20) with catecholamine-resistant distributive shock who were treated with terlipressin were retrospectively enrolled in this study. Read More

    [The 452th case: rash, hypotension, abdominal pain and headache].
    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.
    Systemic lupus erythematosus (SLE) is an autoimmune disease characterized with multiple organ involvements. Acute acalculous cholecystitis(AAC) is an extremely rare manifestation of digestive system involvement in SLE. We reported a case of 32-year-old woman who complained skin rashes for two weeks and stomachache and oliguria for one day. Read More

    Fluid Management for Critically Ill Patients: A Review of the Current State of Fluid Therapy in the Intensive Care Unit.
    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.
    Background: 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

    [Cardiac hemodynamics during shock : Management in daily clinical routine].
    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

    Surgical treatment of pulmonary artery aneurysm: an institutional experience and literature review.
    Interact Cardiovasc Thorac Surg 2016 Sep 25;23(3):438-42. Epub 2016 May 25.
    Department of Cardiac Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science, Beijing, China
    Objectives: The occurrence of pulmonary artery aneurysm (PAA) is extremely rare in the clinical setting. Careful treatment should be considered because of the possibility of fatal complications including rupture, dissection, pulmonary embolism and heart failure. Our goal is to contribute a better understanding of this disease and its treatment. Read More

    [Evaluation of the diagnostic value of bedside ultrasonography in the emergency care].
    Orv Hetil 2016 Apr;157(15):569-74
    Aneszteziológiai és Intenzív Terápiás Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest.
    Introduction: Rapid differential diagnosis of circulatory failure (shock) with unknown etiology is a daily challenge in the field of emergency medicine. The Rapid Ultrasound in Shock (RUSH) protocol is well known since 2010. With the use of targeted steps, the 4 forms of shock (cardiogen, distributive, obstructive, hypovolemic) can be separated in a few minutes. Read More

    Distributive shock, cardiac arrhythmias and multiple organ failure following surgery of a fourth ventricular epidermoid.
    BMJ Case Rep 2016 Mar 31;2016. Epub 2016 Mar 31.
    Department of Neurosurgery, University of Leipzig, Medical Faculty, Leipzig, Germany.
    A 33-years-old male patient presented with cardiac arrhythmias, acute shock and multiple organ dysfunction after the surgical removal of a massive epidermoid posterior to the brainstem. The patient initially presented with paraesthesia along the right C6 dermatome due to a big tumour at the brain stem. Surgical removal was performed without adverse events and he was transferred to our intensive care unit (ICU) immediately after the operation. Read More

    Comparison of volume and attenuation of the spleen between postmortem and antemortem computed tomography.
    Int J Legal Med 2016 Jul 25;130(4):1081-7. Epub 2016 Feb 25.
    Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
    Objectives: The purpose of this study is to compare the postmortem changes in computed tomography (CT) findings between normal spleen, splenic infarct, and splenic tumor infiltration.

    Methods: The institutional review board approved this study, and informed consent was obtained from the next of kin. We studied 63 consecutive subjects who underwent antemortem CT, postmortem CT, and autopsy between February 2012 and December 2013. Read More

    DRESS Syndrome in the ICU: When a Patient Is Treated with Multiple Drugs.
    Case Rep Crit Care 2016 24;2016:9453286. Epub 2016 Jan 24.
    Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, 5 place d'Arsonval, 69003 Lyon, France; Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France.
    The Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is life-threatening. It associates a skin condition with hematological and visceral disorders. The DRESS syndrome diagnosis in the intensive care unit (ICU) is difficult as clinical features are nonspecific. Read More

    Characteristics of 1-day postoperative mortality: a comparison with 2- to 7-day postoperative mortality.
    Acta Anaesthesiol Scand 2016 Apr 13;60(4):432-40. Epub 2016 Jan 13.
    Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
    Background: The purpose of this study was to determine causes and characteristics of early postoperative mortality focusing on postoperative day 1 (POD 1).

    Methods: We reviewed the electronic medical records of patients who died within 7 days after surgery under anesthesia at a tertiary university hospital from January 2004 to December 2014. Postoperative mortalities were divided into POD 1 group and POD 7 group, which included death that occurred from days 2 to 7 after surgery. Read More

    Methylene Blue: Magic Bullet for Vasoplegia?
    Anesth Analg 2016 Jan;122(1):194-201
    From the *Department of Anesthesiology, and †Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
    Methylene blue (MB) has received much attention in the perioperative and critical care literature because of its ability to antagonize the profound vasodilation seen in distributive (also referred to as vasodilatory or vasoplegic) shock states. This review will discuss the pharmacologic properties of MB and review the critical care, liver transplantation, and cardiac anesthesia literature with respect to the efficacy and safety of MB for the treatment of shock. Although improved blood pressure has consistently been demonstrated with the use of MB in small trials and case reports, better oxygen delivery or decreased mortality with MB use has not been demonstrated. Read More

    Multi-drug intoxication fatality involving atorvastatin: A case report.
    Forensic Sci Int 2015 Dec 13;257:e26-31. Epub 2015 Oct 13.
    Department of Medical Chemistry and Biochemistry, Palacky University Olomouc, Faculty of Medicine and Dentistry, Hněvotínská 3, 775 15 Olomouc, Czech Republic. Electronic address:
    Mixed antihypertensive drug intoxication poses a significant risk for patient mortality. In tandem to antihypertensives, hypolipidemic medicines (especially statins) are often prescribed. Among their well-known adverse effects belongs rhabdomyolysis. Read More

    An uncommon cause of distributive shock: Lessons from two consecutive cases of idiopathic systemic capillary leak syndrome (Clarkson's disease).
    Anaesth Crit Care Pain Med 2015 Aug 20;34(4):251-3. Epub 2015 Aug 20.
    Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Médecine Interne-Pathologie Vasculaire, 165, Chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, CNRS, Université Claude-Bernard Lyon 1, Lyon, France.

    A severe case of vasoplegic shock following metformin overdose successfully treated with methylene blue as a last line therapy.
    BMJ Case Rep 2015 Jul 6;2015. Epub 2015 Jul 6.
    Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia.
    A 44-year-old man presented to hospital 24 h after an intentional overdose of metformin and gliclazide. He had a critical metabolic acidosis on presentation with a pH of 6.88, and very rapidly deteriorated into distributive shock refractory to large volume fluid resuscitation and massive doses of vasopressors. Read More

    Methylene blue treatment for cytokine release syndrome-associated vasoplegia following a renal transplant with rATG infusion: A case report and literature review.
    Exp Ther Med 2015 May 12;9(5):1915-1920. Epub 2015 Mar 12.
    Department of Anesthesia, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA.
    Rabbit anti-thymocyte globulin (rATG) is an infusion of polyclonal rabbit-derived antibodies against human thymocyte markers, which can be used to prevent and treat acute rejection following organ transplantation. However, the product monograph issued by the manufacturer (Sanofi Canada) reports that serious immune-mediated reactions have been observed following the use of rATG, consisting of anaphylaxis or severe cytokine release syndrome (CRS), which is a form of vasoplegic syndrome (VS), in which distributive shock occurs refractory to norepinephrine (NE) and vasopressin (VP). Severe infusion-associated reactions are consistent with CRS and can cause serious cardiac or respiratory problems, or in certain cases, mortality. Read More

    BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill.
    Chest 2015 Jun;147(6):1659-1670
    Service de Réanimation Médicale, Hôpital Ambroise-Paré, Boulogne-Billancourt, France. Electronic address:
    This review article describes two protocols adapted from lung ultrasound: the bedside lung ultrasound in emergency (BLUE)-protocol for the immediate diagnosis of acute respiratory failure and the fluid administration limited by lung sonography (FALLS)-protocol for the management of acute circulatory failure. These applications require the mastery of 10 signs indicating normal lung surface (bat sign, lung sliding, A-lines), pleural effusions (quad and sinusoid sign), lung consolidations (fractal and tissue-like sign), interstitial syndrome (lung rockets), and pneumothorax (stratosphere sign and the lung point). These signs have been assessed in adults, with diagnostic accuracies ranging from 90% to 100%, allowing consideration of ultrasound as a reasonable bedside gold standard. Read More

    Mixed amlodipine/valsartan overdose treated by the molecular adsorbent recirculating system (MARS™).
    Clin Toxicol (Phila) 2015 Jul 26;53(6):573-7. Epub 2015 May 26.
    Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain , Brussels , Belgium.
    Case Report: We describe the case of a 58-year-old woman who developed a severe distributive shock following the intentional ingestion of a large overdose of amlodipine (480 mg) combined with valsartan (3680 mg). Extreme vasoplegia remained refractory to maximal standard therapy including fluid resuscitation, intravenous calcium, vasopressors at very high doses, hyperinsulinemia-euglycemia therapy, lipid emulsion, and methylene blue administration. Besides, the patient exhibited hyperglycemia refractory to very high doses of insulin. Read More

    Accuracy of Rapid Ultrasound in Shock (RUSH) Exam for Diagnosis of Shock in Critically Ill Patients.
    Trauma Mon 2015 Feb 20;20(1):e20095. Epub 2015 Feb 20.
    Trauma Research Center, Baqiyatallah University of Medical Science, Tehran, IR Iran.
    Background: Rapid ultrasound in shock (RUSH) is the most recent emergency ultrasound protocol, designed to help clinicians better recognize distinctive shock etiologies in a shorter time frame.

    Objectives: In this study, we evaluated the accuracy of the RUSH protocol, performed by an emergency physician or radiologist, in predicting the type of shock in critical patients.

    Patients And Methods: An emergency physician or radiologist performed the RUSH protocol for all patients with shock status at the emergency department. Read More

    Methylene Blue for Acute Septic Cardiomyopathy in a Burned Patient.
    J Burn Care Res 2016 May-Jun;37(3):e287-91
    From the *Division of Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; †Division of Critical Care Medicine, Department of Anesthesiology, University of Nairobi, Kenya; ‡Department of Pharmacy, Saint Thomas Rutherford Hospital, Murfreesboro, Tennessee and §Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, Tennessee.
    The objective of this case summary was to describe the use of methylene blue (MB) in a burned patient with acute septic cardiomyopathy. A 60-year-old Caucasian man was admitted to the Burn Intensive Care Unit with 45% TBSA burns after a house explosion. During the course of his care, he experienced hypotension that was refractory to fluid therapy and vasoactive medications. Read More

    Accuracy of early rapid ultrasound in shock (RUSH) examination performed by emergency physician for diagnosis of shock etiology in critically ill patients.
    J Emerg Trauma Shock 2015 Jan-Mar;8(1):5-10
    Researcher, Trauma Research Center, Baqiyatallah University of Medical Science, Tehran, Iran.
    Background: Rapid Ultrasound in Shock (RUSH) is a recently reported emergency ultrasound protocol designed to help clinicians better recognize distinctive shock etiologies in a short time. We tried to evaluate the accuracy of early RUSH protocol performed by emergency physicians to predict the shock type in critically ill patients.

    Materials And Methods: Our prospective study was approved by the ethics committee of trauma research center, Baqiyatallah University of Medical Science, Iran. Read More

    Do not drown the patient: appropriate fluid management in critical illness.
    Am J Emerg Med 2015 Mar 4;33(3):448-50. Epub 2015 Feb 4.
    Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The University of Texas Health Science Center at Houston, Houston, TX, USA; The University of Texas Medical Branch at Galveston, Galveston, TX, USA; University General Hospital, Houston, TX, USA.
    Administering intravenous fluids to support the circulation in critically ill patients has been a mainstay of emergency medicine and critical care for decades, especially (but not exclusively) in patients with distributive or hypovolemic shock. However, in recent years, this automatic use of large fluid volumes is beginning to be questioned. Analysis from several large trials in severe sepsis and/or acute respiratory distress syndrome have shown independent links between volumes of fluid administered and outcome; conservative fluid strategies have also been associated with lower mortality in trauma patients. Read More

    Angiotensin II: a new approach for refractory shock management?
    Crit Care 2014 Dec 18;18(6):694. Epub 2014 Dec 18.
    Patients with distributive shock still have a high mortality rate and remain an important issue for intensivists. Management of catecholamine-resistant shock in these patients poses a challenging problem. Despite significant advances in the knowledge of its pathophysiology, all innovative therapeutic approaches and interventions have failed to improve outcome. Read More

    Is this septic shock? A rare case of distributive shock.
    Rev Bras Ter Intensiva 2014 Oct-Dec;26(4):416-20
    Unidade de Urgência Médica, Centro Hospitalar Lisboa Central, Hospital São José, Lisboa, Portugal.
    The authors report a rare case of shock in a patient without significant clinical history, admitted to the intensive care unit for suspected septic shock. The patient was initially treated with fluid therapy without improvement. A hypothesis of systemic capillary leak syndrome was postulated following the confirmation of severe hypoalbuminemia, hypotension, and hemoconcentration--a combination of three symptoms typical of the disease. Read More

    [The effects of Peking Union Medical College Hospital Critical Ultrasonic Management scheme on the etiological diagnosis of dyspnea and/or hemodynamic instability in ICU patients].
    Zhonghua Nei Ke Za Zhi 2014 Oct;53(10):793-8
    Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences,Beijing 100730, China.
    Objective: To investigate the effects of Peking Union Medical College Hospital (PUMCH) Critical Ultrasonic Management (PCUM) scheme on the etiological diagnosis and treatment decisions for the patients with dyspnea and/or hemodynamic instability in ICU.

    Methods: Patients who suffered from dyspnea and/or hemodynamic instability in PUMCH ICU were included in this study. The time to preliminary diagnosis, time to final diagnosis, diagnostic accuracy, time to accurate treatment, time to consultation with other specialties, time to other examinations were recorded. Read More

    Kounis syndrome: a stinging case of ST-elevation myocardial infarction.
    Heart Lung Circ 2015 Apr 16;24(4):e48-50. Epub 2014 Dec 16.
    Department of Cardiology, Banner Good Samaritan Medical Center, Phoenix AZ, 85006.
    Kounis syndrome is not a rare but an infrequently diagnosed non-thrombogenic cause of angina or myocardial infarction triggered by the release of inflammatory mediators following an allergic or anaphylactic reaction. This so-called "allergic angina" is seen in the setting of anaphylactic reactions and is believed to be due to mast cell release causing coronary vasospasm. The treatment of such cases is often with epinephrine, which has also been described in the literature as another rare cause of coronary vasospasm. Read More

    Continuous tissue glucose monitoring correlates with measurement of intermittent capillary glucose in patients with distributive shock.
    Med Intensiva 2015 Oct 12;39(7):405-11. Epub 2014 Dec 12.
    Department of Intensive Care, Hospital Universitario del Tajo, Aranjuez, Spain.
    Background: Intermittent glycemic measurements in patients admitted to the intensive care unit (ICU) can result in episodes of severe hypoglycemia or in a poor control of glycemia range. We designed a study to assess accuracy and reliability of continuous monitoring of tissue glucose for patients with distributive shock.

    Methods: Consecutive patients admitted to the ICU with a diagnosis of distributive shock and the need of insulin infusion for glycemic control were included in the study. Read More

    Postoperative management of dogs with gastric dilatation and volvulus.
    Top Companion Anim Med 2014 Sep 19;29(3):81-5. Epub 2014 Sep 19.
    Department of Small Animal Emergency and Critical Care, the Koret School of Veterinary Medicine, the Hebrew University of Jerusalem, Rehovot, Israel. Electronic address:
    The objective of the study was to review the veterinary literature for evidence-based and common clinical practice supporting the postoperative management of dogs with gastric dilatation and volvulus (GDV). GDV involves rapid accumulation of gas in the stomach, gastric volvulus, increased intragastric pressure, and decreased venous return. GDV is characterized by relative hypovolemic-distributive and cardiogenic shock, during which the whole body may be subjected to inadequate tissue perfusion and ischemia. Read More

    Ten good reasons to practice ultrasound in critical care.
    Anaesthesiol Intensive Ther 2014 Nov-Dec;46(5):323-35
    Over the past decade, critical care ultrasound has gained its place in the armamentarium of monitoring tools. A greater understanding of lung, abdominal, and vascular ultrasound plus easier access to portable machines have revolutionised the bedside assessment of our ICU patients. Because ultrasound is not only a diagnostic test, but can also be seen as a component of the physical exam, it has the potential to become the stethoscope of the 21st century. Read More

    Intravenous angiotensin II for the treatment of high-output shock (ATHOS trial): a pilot study.
    Crit Care 2014 Oct 6;18(5):534. Epub 2014 Oct 6.
    Introduction: Patients with distributive shock who require high dose vasopressors have a high mortality. Angiotensin II (ATII) may prove useful in patients who remain hypotensive despite catecholamine and vasopressin therapy. The appropriate dose of parenteral angiotensin II for shock is unknown. Read More

    Massive Atenolol, Lisinopril, and Chlorthalidone Overdose Treated with Endoscopic Decontamination, Hemodialysis, Impella Percutaneous Left Ventricular Assist Device, and ECMO.
    J Med Toxicol 2015 Mar;11(1):110-4
    Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ, USA,
    Background: Overdose of cardiovascular medications is increasingly associated with morbidity and mortality. We present a case of substantial atenolol, chlorthalidone, and lisinopril overdose treated by multiple modalities with an excellent outcome.

    Conclusion: Aggressive medical intervention did not provide sufficient hemodynamic stability in this patient with refractory cardiogenic and distributive shock. Read More

    Multicenter, randomized, placebo-controlled phase III study of pyridoxalated hemoglobin polyoxyethylene in distributive shock (PHOENIX).
    Crit Care Med 2015 Jan;43(1):57-64
    1Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium. 2Apex Bioscience, Inc., Chapel Hill, NC. 3Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom. 4CIBER Enfermedades Respiratorias, Getafe University Hospital, Universidad Europea, Madrid, Spain. 5Curacyte AG, Munich, Germany. 6Department of Anesthesiology, Intensive Care Medicine and Pain Management, HELIOS Klinikum Erfurt GmbH, Erfurt, Germany. 7Klinik fur Kardiologie, Angiologie and Konservative Intensivmedizin, Vivantes Klinikum Neukoelln, Berlin, Germany. 8Intensive Care Department, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain. 9CIBER Enfermedades Respiratorias, Terrassa, Barcelona, Spain. 10Department of Intensive Care (ICU), Hospital Universitari Dr. Josep Trueta, Girona, Spain. 11Department of Intensive Care, RWTH University Hospital Aachen, Aachen, Germany.
    Objective: To compare the effectiveness and safety of the hemoglobin-based nitric oxide scavenger, pyridoxalated hemoglobin polyoxyethylene, against placebo in patients with vasopressor-dependent distributive shock.

    Design: Multicenter, randomized, placebo-controlled, open-label study.

    Setting: Sixty-one participating ICUs in six European countries (Austria, Belgium, Germany, the Netherlands, Spain, and United Kingdom). Read More

    Early management of severe sepsis: concepts and controversies.
    Chest 2014 Jun;145(6):1407-1418
    Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA. Electronic address:
    Sepsis is among the most common reasons for admission to ICUs throughout the world, and it is believed to be the third most common cause of death in the United States. The pathogenetic mechanism and physiologic changes associated with sepsis are exceedingly complex, but our understanding is evolving rapidly. The major pathophysiologic changes in patients with septic shock include vasoplegic shock (distributive shock), myocardial depression, altered microvascular flow, and a diffuse endothelial injury. Read More

    Diagnosis and management of shock in the emergency department.
    Emerg Med Pract 2014 Mar;16(3):1-22; quiz 22-3
    Shock is a state of acute circulatory failure leading to decreased organ perfusion, with inadequate delivery of oxygenated blood to tissues and resultant end-organ dysfunction. The mechanisms that can result in shock are divided into 4 categories: (1) hypovolemic, (2) distributive, (3) cardiogenic, and (4) obstructive. While much is known regarding treatment of patients in shock, several controversies continue in the literature. Read More

    Anaphylaxis.
    J Emerg Med 2014 Aug 2;47(2):182-7. Epub 2014 Jun 2.
    Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
    Background: Anaphylaxis is the quintessential critical illness in emergency medicine. Symptoms are rapid in onset and death can occur within minutes. Approximately 1500 patients die annually in the United States from this deadly disorder. Read More

    Invasive pulmonary aspergillosis in a patient presenting with idiopathic systemic capillary leak syndrome.
    BMJ Case Rep 2014 May 23;2014. Epub 2014 May 23.
    Department of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto-shi, Kyoto, Japan.
    A 54-year-old man presented to our emergency department with fever and dyspnoea. He required vigorous haemodynamic support and mechanical ventilation for hypotensive distributive shock with hypoalbuminaemia, haemoconcentration, rhabdomyolysis and acute renal failure, consistent with idiopathic systemic capillary leak syndrome. Left lung consolidation and hypoxaemia were observed 6 days after admission. Read More

    The rationale for microcirculatory guided fluid therapy.
    Curr Opin Crit Care 2014 Jun;20(3):301-8
    Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
    Purpose Of Review: The ultimate purpose of fluid administration in states of hypovolemia is to correct cardiac output to improve microcirculatory perfusion and tissue oxygenation. Observation of the microcirculation using handheld microscopes gives insight into the nature of convective and diffusive defect in hypovolemia. The purpose of this article is to introduce a new platform for hemodynamic-targeted fluid therapy based on the correction of tissue and microcirculatory perfusion assumed to be at risk during hypovolemia. Read More

    [Part I. End-stage chronic organ failures: a position paper on shared care planning. The Integrated Care Pathway].
    Recenti Prog Med 2014 Jan;105(1):9-24
    In Italy the birth rate decrease together with the continuous improvement of living conditions on one hand, and the health care progress on the other hand, led in recent years to an increasing number of patients with chronic mono- or multi-organ failures and in an extension of their life expectancy. However, the natural history of chronic failures has not changed and the inescapable disease's worsening at the end makes more rare remissions, increasing hospital admissions rate and length of stay. Thus, when the "end-stage" get close clinicians have to engage the patient and his relatives in an advance care planning aimed to share a decision making process regarding all future treatments and related ethical choices such as patient's best interests, rights, values, and priorities. Read More

    Interpretation of hemolysis tests following administration of a second-generation hemoglobin-based oxygen carrier.
    Acta Clin Belg 2013 Jul-Aug;68(4):282-6
    Department of Laboratory Medicine, Ghent University Hospital, Belgium.
    Hemoglobin released into the circulation during hemolysis or therapy with chemically modified hemoglobins, exert oxidative and NO-scavenging toxic effects. Pyridoxalated hemoglobin polyoxyethylene conjugate (PHP) is one of the second-generation hemoglobin-based oxygen carriers (HBOCs). We wanted to investigate the metabolism of PHP with a special focus on its consequences for interpreting hemolysis-related diagnostic parameters in PHP-treated patients. Read More

    Intravenous lipid emulsion in the management of amlodipine overdose.
    Hosp Pharm 2013 Nov;48(10):848-54
    Assistant Professor, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy.
    Objective: To report a case of amlodipine overdose successfully treated with intravenous lipid emulsion (ILE).

    Case Summary: A 47-year-old, 110 kg female ingested at least 350 mg of amlodipine with an unknown amount of ethanol. Initial blood pressure was 103/57 mm Hg, mean arterial pressure (MAP) 72 mm Hg, and heart rate 113 beats per minute. Read More

    Lung ultrasound in the critically ill.
    Ann Intensive Care 2014 Jan 9;4(1). Epub 2014 Jan 9.
    Service de Réanimation Médicale, Hôpital Ambroise-Paré, University Paris-West, Boulogne, France.
    Lung ultrasound is a basic application of critical ultrasound, defined as a loop associating urgent diagnoses with immediate therapeutic decisions. It requires the mastery of ten signs: the bat sign (pleural line), lung sliding (yielding seashore sign), the A-line (horizontal artifact), the quad sign, and sinusoid sign indicating pleural effusion, the fractal, and tissue-like sign indicating lung consolidation, the B-line, and lung rockets indicating interstitial syndrome, abolished lung sliding with the stratosphere sign suggesting pneumothorax, and the lung point indicating pneumothorax. Two more signs, the lung pulse and the dynamic air bronchogram, are used to distinguish atelectasis from pneumonia. Read More

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