ABSTRACT
La excesiva estimulación simpática está asociada con efectos adversos a nivel cardiovascular y sistémico, que pueden afectar negativamente los resultados en el shock séptico. El bloqueo de los receptores beta adrenérgicos ha mostrado controlar eficazmente el incremento desproporcionado de la frecuencia cardiaca, conservando un perfil hemodinámico favorable y al parecer mejorando la eficiencia del sistema cardiovascular para mantener la perfusión tisular. Adicionalmente, ha mostrado modular favorablemente la inmunosupresión inducida por catecolaminas, así como disminuir la resistencia a la insulina, el catabolismo proteico y la expresión de citocinas proinflamatorias asociadas a disfunción cardiovascular. El bloqueo selectivo de los receptores beta-1 parece ofrecer mejores resultados que el bloqueo no selectivo, sugiriendo incluso un impacto positivo en la mortalidad. Son necesarios futuros ensayos clínicos para confirmar estos hallazgos y definir los alcances de estos beneficios (AU)
In septic shock, high adrenergic stress is associated with cardiovascular and systemic adverse effects, which can negatively affect the results. Beta-adrenergic receptor block has been shown to be effective in controlling the disproportionate increase in heart rate, maintaining a favorable hemodynamic profile and apparently improving the efficiency of the cardiovascular system in order to maintain tissue perfusion. They have also been shown to modulate favorably catecholamine-induced immunosuppression and to decrease insulin resistance, protein catabolism, and proinflammatory cytokine expression associated with cardiovascular dysfunction. Selective beta-1 blockers appear to provide better results than non-selective blockers, even suggesting a positive impact on mortality. Future clinical trials are still needed to confirm these findings and define the scope of their benefits (AU)
Subject(s)
Humans , Male , Female , Shock, Septic/drug therapy , Sepsis/complications , Sepsis/drug therapy , Receptors, Adrenergic, beta , Receptors, Adrenergic, beta/therapeutic use , Heart Rate , Ventricular Dysfunction/complications , Ventricular Dysfunction/drug therapy , Autonomic Nerve Block , Sympathetic Nervous SystemABSTRACT
In septic shock, high adrenergic stress is associated with cardiovascular and systemic adverse effects, which can negatively affect the results. Beta-adrenergic receptor block has been shown to be effective in controlling the disproportionate increase in heart rate, maintaining a favorable hemodynamic profile and apparently improving the efficiency of the cardiovascular system in order to maintain tissue perfusion. They have also been shown to modulate favorably catecholamine-induced immunosuppression and to decrease insulin resistance, protein catabolism, and proinflammatory cytokine expression associated with cardiovascular dysfunction. Selective beta-1 blockers appear to provide better results than non-selective blockers, even suggesting a positive impact on mortality. Future clinical trials are still needed to confirm these findings and define the scope of their benefits.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Hemodynamics/drug effects , Shock, Septic/drug therapy , Adrenergic beta-Antagonists/classification , Adrenergic beta-Antagonists/pharmacology , Clinical Trials as Topic , Cytokines/blood , Drug Evaluation, Preclinical , Forecasting , Humans , Insulin Resistance , Multiple Organ Failure/physiopathology , Multiple Organ Failure/prevention & control , Shock, Septic/physiopathology , Sympathetic Nervous System/physiopathologyABSTRACT
PURPOSE: The continuous monitoring of the cardiac output during liver transplantation (LT) is an essential part of the intraoperative management of the patient's hemodynamics. To verify the accuracy of a new method based on femoral artery thermodilution-calibrated pulse contour analysis (PCCO) during LT, we compared the technique with the results of an intermittent pulmonary artery thermodilution method (ICO). METHOD: A prospective study included 314 paired cardiac output measurements at 10 sampling times in 35 patients undergoing LT. After initial calibration of the pulse contour analysis, no further recalibrations were performed. Bland and Altman's statistical method, one-way ANOVA, and one sample t tests were used for the analysis of the data. A P<.05 was considered significant. RESULTS: There was a small bias 0.18 L x min(-1) (6.29% from the ICO) for the whole sample of paired measurements, associated with 95% limits of agreement of +/-4.72 (68.89%) L x min(-1). The additional analysis showed comparable biases and limits of agreement for any single time in the study period. The difference PCCO-ICO showed a negative sign for ICO >10 L x min(-1) (P<.001) and a positive sign for ICO <5 L x min(-1) (P<.001). It was greater during infusion of a vasoactive drug (P<.001). CONCLUSION: The pulse contour analysis was found to be an unsatisfactory substitute for intermittent thermodilution measurement of cardiac output during the LT.
