Document Detail


Treatment of impaired perfusion in septic shock.
MedLine Citation:
PMID:  12553499     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Severe sepsis and septic shock are relatively common problems in intensive care. The mortality in septic shock is still high, and the main causes of death are multiple organ failure and refractory hypotension. Impaired tissue perfusion due to hypovolemia, disturbed vasoregulation and myocardial dysfunction contribute to the multiple organ dysfunction. Treatment of hemodynamics in septic shock consists of appropriate fluid therapy guided by invasive monitoring combined with vasoactive drugs aiming to correct hypotension and inappropriately low cardiac output. The drug of choice for low vascular resistance is norepinephrine, while insufficient myocardial contractility is commonly treated with dobutamine. The use of norepinephrine seems to be associated with better prognosis as compared to results from the use of dopamine or epinephrine. In septic shock, vasopressin levels are low, and therefore, vasopressin has been advocated as a vasopressor. Its effectiveness and safety have not yet been documented, and so far it is regarded as an experimental treatment Recent data support the use of corticosteroid, at least in some of the patients with septic shock. Also, activated protein C, a drug with anti-inflammatory and antithrombotic properties, decreases mortality in patients with septic shock.
Authors:
Esko Ruokonen; Ilkka Parviainen; Ari Uusaro
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Annals of medicine     Volume:  34     ISSN:  0785-3890     ISO Abbreviation:  Ann. Med.     Publication Date:  2002  
Date Detail:
Created Date:  2003-01-29     Completed Date:  2003-04-28     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8906388     Medline TA:  Ann Med     Country:  Sweden    
Other Details:
Languages:  eng     Pagination:  590-7     Citation Subset:  IM    
Affiliation:
Department of Intensive Care, Kuopio University Hospital, PO Box 1777, FI-70210 Kuopio, Finland. esko.ruokonen@kuh.fi
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use
Dobutamine / therapeutic use
Fibrinolytic Agents / therapeutic use
Fluid Therapy
Humans
Myocardial Contraction
Myocardium / metabolism
Norepinephrine / therapeutic use
Perfusion
Resuscitation
Shock, Septic / physiopathology,  therapy*
Vasopressins / therapeutic use
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Fibrinolytic Agents; 11000-17-2/Vasopressins; 34368-04-2/Dobutamine; 51-41-2/Norepinephrine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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