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SUMMARY OBJECTIVE: The aim of this study was to investigate the efficacy of vasoactive inotrope score at the 24th postoperative hour for mortality and morbidity in elective adult cardiac surgery. METHODS: Consecutive patients who underwent elective adult coronary artery bypass and valve surgery in a single tertiary center for cardiac surgery between December 2021 and March 2022 were prospectively included. The vasoactive inotrope score was calculated with the dosage of inotropes that were continuing at the 24th postoperative hour. Poor outcome was defined as any event of perioperative mortality or morbidity. RESULTS: The study included 287 patients, of whom 69 (24.0%) were on inotropes at the 24th postoperative hour. The vasoactive inotrope score was higher (21.6±22.5 vs. 0.94±2.7, p=0.001) in patients with poor outcome. One unit increase in the vasoactive inotrope score had an odds ratio of 1.24 (95% confidence interval: 1.14-1.35) for poor outcome. The receiver operating characteristic curve of vasoactive inotrope score for poor outcome had an area under the curve of 0.857. CONCLUSION: Vasoactive inotrope score at the 24th hour can be a very valuable parameter for risk calculation in the early postoperative period.
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[Abstract] Objective To monitor the hyporesponsiveness to norepinephrine in heatstroke rats and the improvement of the responsiveness and inflammation by hydrocortisone. Methods Rats were randomized into 4 groups, saline control group, saline heatstroke group, hydrocortisone control group, and hydrocortisone heatstroke group. The carotid blood pressure was monitored in the four groups of rats under anesthesia. The following three parts of experiments were conducted with the sample size 8 in each part of the experiment. (1) The experiment of noradrenaline at two loading doses (1 μg/kg) i.v.. The mean arterial pressure (MAP) and interval time between blood pressure rising and dropping to the baseline were observed in groups of rats after receiving two loading doses of noradrenaline. (2) The experiment of constant low-dose norepinephrine [25 μg/(kg.h)] by continuous pumping injection. The blood pressure level and survival time were observed. (3) The experiment to detect biochemical indicators related to responsiveness. Four groups of rats receiving constant low-dose norepinephrine were sacrificed, and the serum and aortic tissues were collected to measure serum vasodilators (nitric oxide and prostaglandin E2), hormones (cortisol and adrenocorticotropic hormone), pro-inflammatory factors (nuclear factor κB, tumor necrosis factor α, and interleukin 1β) and α1 adrenergic receptor mRNA expression levels in aortic tissues. Results (1) Compared with the saline control group, the mean arterial pressure and interval time between blood pressure rising and dropping to the baseline were significantly decreased in the saline heatstroke group after receiving noradrenaline injection at a loading dose compared with the normal saline control group, especially after the second dose. The hydrocortisone heatstroke group had higher MAP and longer interval time than the saline heatstroke group. The difference was statistically significant (P<0.05). (2) The mean arterial pressure level of the saline heatstroke group was significantly lower than that of the saline control group after receiving a constant low dose of norepinephrine. The mean arterial pressure in the hydrocortisone heatstroke group was increased compared with the saline heatstroke group, and the survival time was prolonged. The difference was statistically significant (P<0.05). (3) The serum nitric oxide, prostaglandin E2, cortisol, and adrenocorticotropic hormone of the saline heatstroke group were not significantly different from those of the saline control group. The levels of pro-inflammatory factors were significantly increased, and the mRNA levels of α1 adrenergic receptors in the aorta were significantly reduced in the saline heatstroke group compared with the saline control group. The decreased pro-inflammatory factors and increased mRNA of α1 adrenergic receptors in the aorta were observed in the hydrocortisone heatstroke group compared with the saline heatstroke group. The difference was statistically significant (P<0.05). Conclusions The hyporesponsiveness to norepinephrine was demonstrated in the heatstroke rats with circulatory failure. Hydrocortisone could increase MAP and survival time, improve the hyporesponsiveness, reduce the inflammatory cytokines and increase the aortic adrenergic receptor expression.
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Resumen: El choque cardiogénico es la mayor catástrofe del infarto agudo al miocardio y de las cardiopatías en general. Se define como un estado en el cual el gasto cardiaco es ineficiente para perfundir y oxigenar los tejidos, por lo que se manifiesta con signos de hipoperfusión tisular y congestión capilar. Aunque las últimas guías no exijan el diagnóstico por medio de medidas hemodinámicas, el basarse sólo en lo clínico puede generar errores hasta en 30%. Las causas se dividen en isquémicas y no isquémicas, siendo la primera la más común. Pese a la aparición de nuevos dispositivos mecánicos, aunados al soporte médico, sólo se ha demostrado la mejora de los desenlaces con las terapias endovasculares.
Abstract: Cardiogenic shock (CSh) is the major catastrophe of acute myocardial infarction (AMI) and heart disease in general. It is defined as a state in which cardiac output (CO) is inefficient to perfuse and oxygenate tissues, which is why it manifests with signs of tissue hypoperfusion and capillary congestion. Although the latest guidelines do not require diagnosis with hemodynamic measures, relying only on the clinical can generate errors up to 30%. The causes are divided into ischemic (AMI) and non-ischemic, with the former being the most common. Despite the appearance of new mechanical devices, coupled with medical support, it has only shown the improvement of outcomes with endovascular therapies.
Resumo: O choque cardiológico (ChC) é a principal catástrofe do infarto agudo do miocárdio (IAM) e das cardiopatias em geral. Definida como um estado no qual o débito cardíaco (DC) é ineficiente para perfundir e oxigenar os tejidos, razão pela qual se manifiesta com sinais de hipoperfusão tecidual e congestão capilar. Embora as diretrizes mais recentes não exijam diagnóstico por meio de medidas hemodinâmicas, depender apenas da clínica pode gerar erros de até 30%. As causas são divididas em isquêmicas (IAM) e não isquêmicas, sendo a primeira a mais comum. Apesar do surgimento de novos dispositivos mecânicos aliados ao suporte médico, só demonstrou-se a melhora dos resultados com terapias endovasculares.
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Resumen La falla cardiaca en una patología poco reconocida en la edad pediátrica y tiene una alta tasa de mortalidad al no ser diagnosticada en forma temprana. Se hace una revisión del diagnóstico, la estratificación y el manejo actual de la falla cardiaca en niños y se mencionan las nuevas terapias actualmente en investigación.
Abstract Heart failure is a little known condition at paediatric age, and has a high mortality rate on not being diagnosed early. A review is presented on its diagnosis, stratification, and current management of heart failure in children, as well the new therapies currently under investigation.
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Humanos , Masculino , Femenino , Recién Nacido , Cardiotónicos , Insuficiencia Cardíaca , Péptido Natriurético Encefálico , CardiomiopatíasRESUMEN
Resumen La falla cardiaca en pacientes pediátricos es una patología poco conocida, que acarrea alta tasa de mortalidad, con sintomatología que puede ser muy inespecífica. Se hace la revisión, presentación, clasificación, fisiopatología y el manejo actual de la falla cardiaca en pacientes pediátricos.
Abstract Heart failure in paediatric patients is a little known condition, but it has a high mortality rate, and with symptoms that can be very non-specific. A review is made of its presentation, classification, pathophysiology and current management of heart failure in paediatric patients.
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Humanos , Masculino , Femenino , Insuficiencia Cardíaca , Cardiomiopatías , Cardiotónicos , Cardiopatías CongénitasRESUMEN
Inotropic agents used widely in heart failure and shock.The mechanism,use and contro-versy of digitalis,catecholamines,phosphodiesterase inhibitors,calcium sensitizer and new inotropics are reviewed,in order to guide appropriate selection and application of inotropics in clinics.
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Resumen Objetivo: describir los perfiles clínicos y hemodinámicos de pacientes hospitalizados por falla cardíaca aguda. Métodos: estudio transversal de pacientes de 18 años o más, con diagnóstico de falla cardíaca aguda admitidos a un centro hospitalario de alta complejidad en Cali, Colombia, en un período de 7 meses. Se recolectó información sociodemográfica, clínica, perfiles clínicos y hemodinámicos de la falla cardiaca al ingreso, estancia hospitalaria y mortalidad. Se describieron las variables cuantitativas como promedios o medianas, y las categóricas como valor absoluto y porcentajes. Se realizaron tablas de frecuencia, y se graficaron los porcentajes de pacientes que ingresaron según el perfil clínico y hemodinámico de falla cardiaca aguda. Resultados: se incluyeron 99 pacientes con 143 episodios de falla cardíaca aguda. La mitad eran hombres y la mediana de edad 66 años (rango 21 a 97 años). 60% fueron afrodescendientes y 14,14% mestizos. Los perfiles clínicos más frecuentes fueron falla cardíaca aguda descompensada (72,46%), edema pulmonar agudo (10,14%) y falla cardiaca asociada a síndrome coronario agudo en 6,52%. Los perfiles hemodinámicos fueron ''caliente y seco'' 10,87%, ''caliente y húmedo'' 55,07%, ''frío y húmedo'' 28,26% y ''frío y seco'' en 5,8%. Conclusiones: la falla cardíaca aguda descompensada es el perfil de presentación clínica más común en nuestra población con dos tercios del total de casos. El perfil hemodinámico más frecuente fue el ''caliente y húmedo'' (Stevenson B), resultados que concuerdan con lo observado en estudios locales y registros internacionales.
Abstract Objective: To describe the clinical and haemodynamic profiles of patients admitted to hospital due to acute heart failure. Methods: A cross-sectional study was conducted on patients aged 18 years or older with a diagnosis of acute heart failure admitted to a high complexity hospital in Cali, Colombia, during a 7-month period. Sociodemographic, clinical and haemodynamic information of the cardiac failure was recorded on admission, as well as hospital stay and mortality. The quantitative variables are described as means or medians, and the categorical variables as absolute value and percentages. Frequency tables were made, and a graph made of the percentages of patients admitted, according to the clinical and haemodynamic profile of the acute heart failure. Results: The study included as total of 99 patients with 143 episodes of acute heart failure. Half of the patients were male, and the median age was 66 years (range 21 to 97 years). The majority (60%) were of African descent and 14.14% were Mestizos. The most common clinical profiles were decompensated heart failure (72.46%), acute pulmonary edema (10.14%), and heart failure associated with acute coronary syndrome in 6.52%. The haemodynamic profiles were ''warm and dry'' in 10.87%, ''warm and wet'' in 55.07%, ''cold and wet'' in 28.26%, and ''cold and dry'' in 5.8%. Conclusions: Decompensated acute heart failure is the most common clinical presentation profile in the population studied, with two-thirds of all cases. The most frequent haemodynamic profile was ''warm and wet'', results that agree with those observed in local studies and in international registers.
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Humanos , Insuficiencia Cardíaca , Cardiotónicos , MortalidadRESUMEN
Acute heart failure is defined as a rapid onset or change in the signs and symptoms of heart failure,resulting in the need for urgent therapy.This article reviews new information relating to the diagnosis and treatment of AHF.