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Leclercq C, Rouge J, Burtin P, Roussiaux A, Ducrocq N, Halchini C. Left ventricular strain variations in cardiac surgery; The role of the type of surgery. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bigeon JY, Rouge J, Berthezene R, Ducrocq N, Roussiaux A, Burtin P. Perioperative LV strain (avgGLS) alteration and long-term incidence of MACE in cardiac surgery. J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2018.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kimmoun A, Novy E, Auchet T, Ducrocq N, Levy B. Erratum to: Hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside. Crit Care 2017; 21:40. [PMID: 28219394 PMCID: PMC5319096 DOI: 10.1186/s13054-017-1624-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 11/10/2022] Open
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Kimmoun A, Baux E, Das V, Terzi N, Talec P, Asfar P, Ehrmann S, Geri G, Grange S, Anguel N, Demoule A, Moreau AS, Azoulay E, Quenot JP, Boisramé-Helms J, Louis G, Sonneville R, Girerd N, Ducrocq N, Agrinier N, Wahl D, Puéchal X, Levy B. Outcomes of patients admitted to intensive care units for acute manifestation of small-vessel vasculitis: a multicenter, retrospective study. Crit Care 2016; 20:27. [PMID: 26812945 PMCID: PMC4729170 DOI: 10.1186/s13054-016-1189-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/14/2016] [Indexed: 11/25/2022]
Abstract
Background The outcomes of patients admitted to the intensive care unit (ICU) for acute manifestation of small-vessel vasculitis are poorly reported. The aim of the present study was to determine the mortality rate and prognostic factors of patients admitted to the ICU for acute small-vessel vasculitis. Methods This retrospective, multicenter study was conducted from January 2001 to December 2014 in 20 ICUs in France. Patients were identified from computerized registers of each hospital using the International Classification of Diseases, Ninth Revision (ICD-9). Inclusion criteria were (1) known or highly suspected granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis (respectively, ICD-9 codes M31.3, M30.1, and M31.7), or anti–glomerular basement membrane antibody disease (ICD-9 codes N08.5X-005 or M31.0+); (2) admission to the ICU for the management of an acute manifestation of vasculitis; and (3) administration of a cyclophosphamide pulse in the ICU or within 48 h before admission to the ICU. The primary endpoint was assessment of mortality rate 90 days after admission to the ICU. Results Eighty-two patients at 20 centers were included, 94 % of whom had a recent (<6 months) diagnosis of small-vessel vasculitis. Forty-four patients (54 %) had granulomatosis with polyangiitis. The main reasons for admission were respiratory failure (34 %) and pulmonary-renal syndrome (33 %). Mechanical ventilation was required in 51 % of patients, catecholamines in 31 %, and renal replacement therapy in 71 %. Overall mortality at 90 days was 18 % and the mortality in ICU was 16 %. The main causes of death in the ICU were disease flare in 69 % and infection in 31 %. In univariable analysis, relevant factors associated with death in nonsurvivors compared with survivors were Simplified Acute Physiology Score II (median [interquartile range] 51 [38–82] vs. 36 [27–42], p = 0.005), age (67 years [62–74] vs. 58 years [40–68], p < 0.003), Sequential Organ Failure Assessment score on the day of cyclophosphamide administration (11 [6–12] vs. 6 [3–7], p = 0.0004), and delayed administration of cyclophosphamide (5 days [3–14] vs. 2 days [1–5], p = 0.0053). Conclusions Patients admitted to the ICU for management of acute small-vessel vasculitis benefit from early, aggressive intensive care treatment, associated with an 18 % death rate at 90 days. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1189-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antoine Kimmoun
- Brabois Medical Intensive Care Unit, Nancy University Hospital, Vandoeuvre-les-Nancy, Nancy, 54000, France.,INSERM U1116, Vandoeuvre-les-Nancy, Nancy, France
| | - Elisabeth Baux
- Brabois Medical Intensive Care Unit, Nancy University Hospital, Vandoeuvre-les-Nancy, Nancy, 54000, France.,INSERM U1116, Vandoeuvre-les-Nancy, Nancy, France
| | - Vincent Das
- Medical-Surgical Intensive Care Unit, Andre Gregoire District Hospital Center, Montreuil, F-93105, France
| | - Nicolas Terzi
- Medical Intensive Care Unit, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Patrice Talec
- Medical Intensive Care Unit, Angers University Hospital, Angers, F-49933, France
| | - Pierre Asfar
- Medical Intensive Care Unit, Angers University Hospital, Angers, F-49933, France
| | - Stephan Ehrmann
- Medical Intensive Care Unit, Bretonneau University Hospital, Tours, F-37044, France
| | - Guillaume Geri
- Medical Intensive Care Unit, Cochin University Hospital, Paris, F-75014, France
| | - Steven Grange
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, 76031, France
| | - Nadia Anguel
- Medical Intensive Care Unit, Kremlin-Bicêtre University Hospital, Paris, F-94275, France
| | - Alexandre Demoule
- Medical Intensive Care Unit and Respiratory Division, Pitié-Salpêtrière University Hospital, Paris, 75013, France
| | - Anne Sophie Moreau
- Medical-Surgical Intensive Care Unit, Lille University Hospital, Lille, F-59000, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, Paris, 75010, France
| | - Jean-Pierre Quenot
- Medical Intensive Care Unit, Dijon University Hospital, Dijon, F-21079, France
| | - Julie Boisramé-Helms
- Medical Intensive Care Unit, NHC University Hospital, Strasbourg, F-67091, France
| | - Guillaume Louis
- Medical Intensive Care Unit, Mercy Regional Hospital, Ars-Laquenexy, 57530, France
| | - Romain Sonneville
- Medical Intensive Care Unit, Bichat - Claude-Bernard University Hospital, Paris, 75018, France
| | - Nicolas Girerd
- INSERM CIC1433, Nancy University Hospital, Nancy, 54000, France
| | - Nicolas Ducrocq
- Brabois Medical Intensive Care Unit, Nancy University Hospital, Vandoeuvre-les-Nancy, Nancy, 54000, France.,INSERM U1116, Vandoeuvre-les-Nancy, Nancy, France
| | - Nelly Agrinier
- INSERM CIC-EC, CIE6, Nancy University Hospital, Nancy, 54000, France
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy University Hospital, Vandoeuvre-les Nancy, Nancy, 54511, France
| | - Xavier Puéchal
- National Referral Center for Necrotizing Vasculitides and Systemic Sclerosis, Cochin Hospital, University Paris Descartes, Paris, F-75014, France
| | - Bruno Levy
- Brabois Medical Intensive Care Unit, Nancy University Hospital, Vandoeuvre-les-Nancy, Nancy, 54000, France. .,INSERM U1116, Vandoeuvre-les-Nancy, Nancy, France.
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Abstract
Lactic acidosis is a very common biological issue for shock patients. Experimental data clearly demonstrate that metabolic acidosis, including lactic acidosis, participates in the reduction of cardiac contractility and in the vascular hyporesponsiveness to vasopressors through various mechanisms. However, the contributions of each mechanism responsible for these deleterious effects have not been fully determined and their respective consequences on organ failure are still poorly defined, particularly in humans. Despite some convincing experimental data, no clinical trial has established the level at which pH becomes deleterious for hemodynamics. Consequently, the essential treatment for lactic acidosis in shock patients is to correct the cause. It is unknown, however, whether symptomatic pH correction is beneficial in shock patients. The latest Surviving Sepsis Campaign guidelines recommend against the use of buffer therapy with pH ≥7.15 and issue no recommendation for pH levels <7.15. Furthermore, based on strong experimental and clinical evidence, sodium bicarbonate infusion alone is not recommended for restoring pH. Indeed, bicarbonate induces carbon dioxide generation and hypocalcemia, both cardiovascular depressant factors. This review addresses the principal hemodynamic consequences of shock-associated lactic acidosis. Despite the lack of formal evidence, this review also highlights the various adapted supportive therapy options that could be putatively added to causal treatment in attempting to reverse the hemodynamic consequences of shock-associated lactic acidosis.
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Affiliation(s)
- Antoine Kimmoun
- CHU Nancy, Service de Réanimation Médicale Brabois, Pole Cardiovasculaire et Réanimation Médicale, Hôpital de Brabois, Vandoeuvre-les-Nancy, 54511, France. .,Université de Lorraine, Nancy, 54000, France. .,INSERM U1116, Groupe Choc, Faculté de Médecine, Vandoeuvre-les-Nancy, 54511, France.
| | - Emmanuel Novy
- CHU Nancy, Service de Réanimation Médicale Brabois, Pole Cardiovasculaire et Réanimation Médicale, Hôpital de Brabois, Vandoeuvre-les-Nancy, 54511, France. .,Université de Lorraine, Nancy, 54000, France.
| | - Thomas Auchet
- CHU Nancy, Service de Réanimation Médicale Brabois, Pole Cardiovasculaire et Réanimation Médicale, Hôpital de Brabois, Vandoeuvre-les-Nancy, 54511, France.
| | - Nicolas Ducrocq
- CHU Nancy, Service de Réanimation Médicale Brabois, Pole Cardiovasculaire et Réanimation Médicale, Hôpital de Brabois, Vandoeuvre-les-Nancy, 54511, France.
| | - Bruno Levy
- CHU Nancy, Service de Réanimation Médicale Brabois, Pole Cardiovasculaire et Réanimation Médicale, Hôpital de Brabois, Vandoeuvre-les-Nancy, 54511, France. .,Université de Lorraine, Nancy, 54000, France. .,INSERM U1116, Groupe Choc, Faculté de Médecine, Vandoeuvre-les-Nancy, 54511, France.
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Ducrocq N, Kimmoun A, Levy B. Lactate or ScvO2 as an endpoint in resuscitation of shock states? Minerva Anestesiol 2013; 79:1049-1058. [PMID: 24042154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In the current management of critically ill patients, variables such as blood pressure, urine output or central venous pressure guide resuscitative efforts. Unfortunately, global tissue hypoxia may persist leading to multiple organ failure and death. To address tissue well-being, indices such as central venous oxygen saturation (ScvO2) and Lactatemia are widely used and are strongly linked to outcome. Implementing these indices in haemodynamic optimization protocols have been shown to reduce morbidity and mortality in numerous studies especially in septic shock. Nevertheless, choosing one index over the other remains controversial. Herein, we review the physiology and rationale for ScvO2 and lactate monitoring. Clinical uses, evidence-based outcome implications and limitations are also examined to aid the clinician in daily practice.
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Affiliation(s)
- N Ducrocq
- Service Réanimation Médicale, Chu Nancy-Hopitaux de Brabois, Vandoeuvre les Nancy, Nancy, France -
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Aslam R, Ducrocq N, Thivilier C, Perez P, Gerard A, Kimmoun A, Levy B. Critical illness-related corticosteroid insufficiency in cardiogenic shock. Br J Anaesth 2013; 111:512-3. [DOI: 10.1093/bja/aet271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kimmoun A, Ducrocq N, Mory S, Delfosse R, Muller L, Perez P, Fay R, Levy B. Cardiac contractile reserve parameters are related to prognosis in septic shock. Biomed Res Int 2013; 2013:930673. [PMID: 23957012 PMCID: PMC3730160 DOI: 10.1155/2013/930673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 06/10/2013] [Accepted: 06/24/2013] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Cardiac reserve could be defined as the spontaneous magnitude from basal to maximal cardiac power under stress conditions. The aim of this study was to evaluate the prognostic value of cardiac reserve parameters in resuscitated septic shock patients. METHODS Seventy patients with septic shock were included in a prospective and observational study. Prior to inclusion, patients were resuscitated to reach a mean arterial pressure of 65-75 mmHg with an euvolemic status. General, hemodynamic, and cardiac reserve-related parameters (cardiac index, double product, and cardiac power index) were collected at inclusion and at day 1. RESULTS Seventy patients were included with 28-day mortality at 38.5%. Ten of the 70 patients died during the first day. In multivariate analysis, independent predictors of death were SAPS II ≥ 58 (OR: 3.36 [1.11-10.17]; P = 0.032), a high double product at inclusion (OR [95% IC]: 1.20 [1.00-1.45] per 10(3) mmHg · min; P = 0.047), and at day 1, a decrease in cardiac index (1.30 [1.08-1.56] per 0.5 L/min/m(2); P = 0.007) or cardiac power index (1.84 [1.18-2.87] per 0.1 W/m(2), P = 0.008). CONCLUSION In the first 24 hours, parameters related to cardiac reserve, such as double product and cardiac index evolution, provide crucial and easy to achieve hemodynamic physiological information, which may impact the outcome.
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Affiliation(s)
- Antoine Kimmoun
- Service de Réanimation Médicale Brabois, CHU de Nancy, 54511 Vandoeuvre les Nancy, France.
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Kimmoun A, Guerci P, Bridey C, Ducrocq N, Vanhuyse F, Levy B. Prone positioning use to hasten veno-venous ECMO weaning in ARDS. Intensive Care Med 2013; 39:1877-9. [DOI: 10.1007/s00134-013-3007-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2013] [Indexed: 11/24/2022]
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Ducrocq N, Kimmoun A, Levy B. LACTATE or ScvO2 as an endpoint in resuscitation of shock states? Minerva Anestesiol 2013:R02Y9999N00A0643. [PMID: 23811621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In the current management of critically ill patients, variables such as blood pressure, urine output or central venous pressure guide resuscitative efforts. Unfortunately, global tissue hypoxia may persist leading to multiple organ failure and death. To address tissue well-being, indices such as central venous oxygen saturation (ScvO2) and lactataemia are widely used and are strongly linked to outcome. Implementing these indices in haemodynamic optimization protocols have been shown to reduce morbidity and mortality in numerous studies especially in septic shock. Nevertheless, choosing one index over the other remains controversial. Herein, we review the physiology and rationale for ScvO2 and lactate monitoring. Clinical uses, evidence-based outcome implications and limitations are also examined to aid the clinician in daily practice. Key words: lactate, central venous oxygen saturation, shock, goal-directed therapy.
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Affiliation(s)
- N Ducrocq
- Service Réanimation Médicale, CHU NANCY - HOPITAUX DE BRABOIS, VANDOEUVRE LES NANCY, FRANCE -
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Kimmoun A, Ducrocq N, Levy B. Mechanisms of vascular hyporesponsiveness in septic shock. Curr Vasc Pharmacol 2013; 11:139-149. [PMID: 23506493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Revised: 04/18/2012] [Accepted: 04/20/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE To define some of the most common characteristics of vascular hyporesponsiveness to catecholamines during septic shock and outline current therapeutic approaches and future perspectives. METHODS Source data were obtained from a PubMed search of the medical literature with the following MeSH terms: Muscle, smooth, vascular/physiopathology; hypotension/etiology; shock/physiopathology; vasodilation/physiology; shock/therapy; vasoconstrictor agents. RESULTS NO and peroxynitrite are mainly responsible for vasoplegia and vascular hyporeactivity while COX 2 enzyme is responsible for the increase in PGI2, which also contributes to hyporeactivity. Moreover, K+ATP and BKCa channels are over-activated during septic shock and participate in hypotension. Finally, other mechanisms are involved in vascular hyporesponsiveness such as critical illness-related corticosteroid insufficiency, vasopressin depletion, dysfunction and desensitization of adrenoreceptors as well as inactivation of catecholamines by oxidation. CONCLUSION In animal models, several therapeutic approaches, targeted on one particular compound have proven their efficacy in preventing or reversing vascular hyporesponsiveness to catecholamines. Unfortunately, none have been successfully tested in clinical trials. Nevertheless, very high doses of catecholamines ( > 5 μg/kg/min), hydrocortisone, terlipressin or vasopressin could represent an alternative for the treatment of refractory septic shock.
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Affiliation(s)
- Antoine Kimmoun
- Service de Réanimation Médicale Brabois, CHU de Nancy – Institut Lorrain du Coeur et des Vaisseaux, Rue du Morvan, Vandoeuvre cedex, Vandoeuvre les Nancy, France
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Grein E, Ducrocq N, Kimmoun A, Vanhuyse F, Gerard A, Levy B. [Sickle cell disease and life-threatening acute chest syndrome: Interest of extracorporeal life support]. ACTA ACUST UNITED AC 2012; 31:973-5. [PMID: 23159514 DOI: 10.1016/j.annfar.2012.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 10/04/2012] [Indexed: 01/21/2023]
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Ducrocq N, Bridey C, Lévy B. [The pathophysiology of septic shock]. Soins 2012:34-35. [PMID: 22870765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Understanding of the pathophysiology of septic shock has benefitted from recent advances. These advances enable the validation of current treatment but also the development of new therapeutic approaches.
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Affiliation(s)
- Nicolas Ducrocq
- Service de réanimation médicale, CHU Nancy-Brabois, Vandoeuvre-les-Nancy.
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Bridey C, Mathieu S, Steiger M, Trari V, Lavoivre C, Ducrocq N, Levy B, Gérard A, Augros J. [Nursing management of ventilation and sedation in patients suffering from septic shock]. Soins 2012:38-41. [PMID: 22870767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A significant number of intubated, ventilated and sedated patients suffering from septic shock develop acute respiratory distress syndrome (ARDS). The supervision by a multidisciplinary team optimises both the management of ventilation and the sedation analgesia of the patient. The nursing supervision and care related to this pathology are specific.
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Affiliation(s)
- Céline Bridey
- Service de réanimation médicale, CHU Nancy-Brabois, Vandoeuvre-les-Nancy.
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Levy B, Collin S, Sennoun N, Ducrocq N, Kimmoun A, Asfar P, Perez P, Meziani F. Vascular hyporesponsiveness to vasopressors in septic shock: from bench to bedside. Intensive Care Med 2010; 36:2019-29. [PMID: 20862451 DOI: 10.1007/s00134-010-2045-8] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 08/24/2010] [Indexed: 01/20/2023]
Abstract
PURPOSE To delineate some of the characteristics of septic vascular hypotension, to assess the most commonly cited and reported underlying mechanisms of vascular hyporesponsiveness to vasoconstrictors in sepsis, and to briefly outline current therapeutic strategies and possible future approaches. METHODS Source data were obtained from a PubMed search of the medical literature with the following MeSH terms: Muscle, smooth, vascular/physiopathology; hypotension/etiology; shock/physiopathology; vasodilation/physiology; shock/therapy; vasoconstrictor agents. RESULTS Nitric oxide (NO) and peroxynitrite are crucial components implicated in vasoplegia and vascular hyporeactivity. Vascular ATP-sensitive and calcium-activated potassium channels are activated during shock and participate in hypotension. In addition, shock state is characterized by inappropriately low plasma glucocorticoid and vasopressin concentrations, a dysfunction and desensitization of alpha-receptors, and an inactivation of catecholamines by oxidation. Numerous other mechanisms have been individualized in animal models, the great majority of which involve NO: MEK1/2-ERK1/2 pathway, H(2)S, hyperglycemia, and cytoskeleton dysregulation associated with decreased actin expression. CONCLUSIONS Many therapeutic approaches have proven their efficiency in animal models, especially therapies directed against one particular compound, but have otherwise failed when used in human shock. Nevertheless, high doses of catecholamines, vasopressin and terlipressin, hydrocortisone, activated protein C, and non-specific shock treatment have demonstrated a partial efficiency in reversing sepsis-induced hypotension.
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Affiliation(s)
- B Levy
- Groupe Choc, Contrat Avenir INSERM 2006, Faculté de Médecine, Nancy Université, 9 Avenue de la Forêt de Haye, BP 184, Vandœuvre-lès-Nancy Cedex, 54505, France.
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