Cardiogenic Shock

Vahdatpour, Cyrus; Collins, D. A.; Goldberg, Sheldon

doi:10.1161/jaha.119.011991

Cited by 311 publications

(259 citation statements)

References 68 publications

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“…Thus, patients were enrolled if they met at least one of the following clinical inclusion criteria: (1) Glasgow Coma Scale <12 12 ; (2) PaO2/FiO2 < 300, respiratory rate <8/min or>20/min, accessory muscle use 13 ; (3) mean arterial pressure <70 mmHg, urine output <0,5 mL/kg/hr, use of inotrope or vasopressors 14,15 .…”

mentioning

confidence: 99%

The Prognostic Role of Procalcitonin in Critically Ill Patients Admitted in a Medical Stepdown Unit: A Retrospective Cohort Study

Zaccone

Falsetti

Nitti

et al. 2020

Sci Rep

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Procalcitonin (PCT) is a a marker of bacterial infection. Its prognostic role in the critically-ill patient, however, is still object of debate. Aim of this study was to evaluate the capacity of admission PCT (apct) in assessing the prognosis of the critically-ill patient regardless the presence of bacterial infection. A single-cohort, single-center retrospective study was performed evaluating critically-ill patients admitted to a stepdown care unit. Age, sex, Simplified Acute Physiology Score II (SAPS-II), shock, troponin-I, aPCT, serum creatinine, cultures and clinical endpoints (in-hospital mortality or Intensive Care Unit (ICU) transfer) were collected. Time free from adverse event (TF-AE) was defined as the time between hospitalization and occurrence of one of the clinical endpoints, and calculated with Kaplan-Meier curves. We engineered a new predictive model (POCS) adopting aPCT, age and shock. We enrolled 1063 subjects: 450 reached the composite outcome of death or ICU transfer. aPCT was significantly higher in this group, where it predicted TF-AE both in septic and non-septic patients. aPCT and POCS showed a good prognostic performance in the whole sample, both in septic and non-septic patients. aPCT showed a good prognostic accuracy, adding informations on the rapidity of clinical deterioration. pocS model reached a performance similar to SApS-ii. Procalcitonin (PCT) is a pro-hormone of human calcitonin synthesized by the parafollicular C cells of the thyroid and involved in calcium homeostasis. PCT is produced in large quantities by different cell types in patients affected by bacterial infections 1. Several studies have shown low-to moderately-elevated PCT levels also among critically-ill patients without evidence of infection (trauma, major surgery, multi-organ failure and myocardial infarction) 2,3. Clinically, PCT represents a quantitative biomarker which is currently used to help predicting the probability of bacterial infections 4 and guide the duration of antibiotic therapy 5. PCT demonstrated not only a diagnostic, but also an elevated prognostic value in septic patients. A recent meta-analysis concluded that increased PCT concentrations and absence of PCT clearance were strongly associated with all-cause mortality in septic patients 6. Clinical and pathophysiological data suggest a role of PCT in prognostic evaluation of critically-ill patients regardless the presence of a bacterial infection 7 , but large and conclusive data are still lacking. Main objective of the present study was to assess the prognostic value of PCT, evaluated as a single assay at the admission (aPCT) within the first 12 hours, in critically-ill patients regardless of the presence of bacterial infection. We also engineered a new predictive model, named "Procalcitonin and Other Clinical Score" (POCS), adopting both clinical and laboratoristic variables (aPCT, age and shock), to improve the prediction of outcomes and compared its performances with other validated prognostic markers, as Troponin I (TnI) 8 and the Simplified ...

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mentioning

confidence: 99%

The Prognostic Role of Procalcitonin in Critically Ill Patients Admitted in a Medical Stepdown Unit: A Retrospective Cohort Study

Zaccone

Falsetti

Nitti

et al. 2020

Sci Rep

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“…The cardiogenic shock was diagnosed based on the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) definition: systolic blood pressure of 90 mmHg that requires more than 30 minutes of inotropic support. Exclusion of sepsis was supported by the normal value of serum procalcitonin apart from the corroborative echo finding of severe LV dysfunction [ 8 ]. In this patient, despite low oxygen saturation, the CT scan was clear, and the low saturation could be explained by central oxygenation impairment apart from peripheral vasoconstriction due to low cardiac output and inotropes that were being administered to the patient.…”

Section: Discussionmentioning

confidence: 99%

A Case of Hemolytic Anemia With Acute Myocarditis and Cardiogenic Shock: A Rare Presentation of COVID-19

Singhavi¹,

Sharma²,

Desai³

et al. 2020

Cureus

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Coronavirus disease 2019 (COVID-19) cases are on the rise globally, and mortality- and survival-related data are emerging every day. In addition, upcoming reports are suggestive of increased risk of cardiac ailments in high-risk patients. In the context of cardiac involvement, acute myocarditis has become one of the unexplored areas in COVID-19 patients, which could influence the long-term outcomes. In this report, we present a rare case that warrants further study on the subject due to the paucity of data in the literature. To date, no case of severe hemolytic anemias with stress cardiomyopathy/acute myocarditis in a patient of COVID-19 has been formally reported in the literature. The bedside echocardiogram had shown a possibility of acute myocarditis. The patient’s marked left ventricular (LV) functional recovery without coronary intervention further corroborates the same. Clinicians should be aware of the diversity of cardiovascular/hematological complications, as well as focused cardiac ultrasound study and the importance of echocardiography as a good screening modality for cardiovascular and hematological complications of COVID-19 infection.

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“…Indeed, infusion of landiolol by our system decreased AP and CO. Although there is no clear clinical evidence of acceptable AP values under acute HF condition, previous studies recommended to maintain mean AP of over 65 mmHg for cardiogenic shock [36] or following septic shock [37]. Therefore, we set AP* as 10 to 15 mmHg lower than baseline mean AP, but not lower than 70 mmHg.…”

Section: The Bene T Of High Dose β-Blockersmentioning

confidence: 99%

Development of an Automated Drug Delivery System for an Ultra-Short-acting β-Blocker, Landiolol, to Stably Reduce Myocardial Oxygen Consumption without Inducing Circulatory Collapse in a Canine Heart Failure Model

Nishikawa¹,

Uemura²,

Hayama³

et al. 2020

Preprint

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Background: Beta-blockers are well known to reduce myocardial oxygen consumption (MVO2) and improve the prognosis of heart failure (HF) patients. Although the use of β-blockers in the acute phase of HF can be expected to be beneficial, the negative chronotropic and inotropic effects limit their use due to the risk of circulatory collapse (cardiogenic shock, and/or pulmonary congestion). A safe method to administer β-blockers in the acute phase of HF is in great need. In this study, we developed an automated drug delivery system that controls the infusion of landiolol, an ultra-short-acting β-blocker, while preventing circulatory collapse. Method: We designed a system that simultaneously regulates cardiac function and volume status to control haemodynamics. The system monitors arterial pressure (AP), left atrial pressure (PLA), right atrial pressure, and cardiac output. Using negative feedback of haemodynamics, the system controls mean AP and mean PLA by administering landiolol, dextran, and furosemide. We applied the system for 60 min to 5 mongrel dogs with rapid pacing-induced HF, and assessed haemodynamics, MVO2 and lactate.Results: In all dogs, the system successfully adjusted delivery of the drugs resulting in accurate control of mean AP and mean PLA. From 15 to 60 min after the system was activated, median of absolute performance error (index of precision of control) was small for mean AP (median [interquartile range], 2.5 [2.1 – 3.7] %) and mean PLA (4.1 [1.8 – 6.2] %). Although the system decreased mean AP compared to baseline, mean and systolic AP were maintained not lower than 70 and 100 mmHg, respectively, and lactate did not increase. Furthermore, the system significantly decreased PLA and MVO2 (3.6 [3.3 – 4.0] to 2.7 [2.5 – 3.3] ml·min-1·100 g left ventricular weight-1) compared to baseline. Consequently, the automated drug delivery system successfully reduced MVO2 without inducing circulatory collapse.Conclusion: We developed an automated landiolol delivery system that achieved safe administration of landiolol in a canine model of acute HF. The system controlled AP and PLA accurately and stably, and reduced MVO2. With further development for clinical application, the automated drug delivery system may be the key tool to improve management of patients with HF.

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Cardiogenic Shock

Cited by 311 publications

References 68 publications

The Prognostic Role of Procalcitonin in Critically Ill Patients Admitted in a Medical Stepdown Unit: A Retrospective Cohort Study

The Prognostic Role of Procalcitonin in Critically Ill Patients Admitted in a Medical Stepdown Unit: A Retrospective Cohort Study

A Case of Hemolytic Anemia With Acute Myocarditis and Cardiogenic Shock: A Rare Presentation of COVID-19

Development of an Automated Drug Delivery System for an Ultra-Short-acting β-Blocker, Landiolol, to Stably Reduce Myocardial Oxygen Consumption without Inducing Circulatory Collapse in a Canine Heart Failure Model

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