Historical perspectives in critical care medicine: blood transfusion, intravenous fluids, inotropes/vasopressors, and antibiotics.

Significant progress in critical care medicine has been the result of tireless observation, dedicated research, and well-timed serendipity. This article provides a historical perspective for four meaningful therapies in critical care medicine: blood transfusion, fluid resuscitation, vasopressor/inotropic support, and antibiotics. For each therapy, key discoveries and events that have shaped medical history and helped define current practice are discussed. Prominent medical and social pressures that have catalyzed research and innovation in each domain are also addressed, as well as current and future challenges.

[Digitalic therapy. Historical outline]. / Acerca de la terapéutica digitálica. Bosquejo histórico.

The action of medical drugs obtained from many vegetables aroused a great interest of naturalists and physicians in all time. Moreover, it was always required that those persons destined to medical practice have a good knowledge of botany. Among the medicinal plants utilized by ancient peoples of the Anahuac, yoloxochitl or heart flower (Talauma mexicana) is mentioned, which seems to have a digitalis-like action. Research in our century demonstrated a positive inotropic and bradycardic effect of the leavels of Magnolia grandiflora or Talauma mexicana extract. Since the end of the XVIII century, digitalis was employed. It was considered initially as a diuretic and later as a cardiotonic agent. The action of digitalic glycosides upon the cardiac tissues was studied experimentally in Mexico. At the present-time there are positive inotropic agents derived from pyridine, as is the case of Milrinone, which have a beneficial action on the failing human myocardium. However, following the opinion of distinguished pharmacologists, "in the case of heart failure associated to atrial fibrillation, digitalis cannot be substituted".

Acerca de la terapéutica digitálica. Bosquejo histórico / On digatalic therapy

La acción de medicamentos derivados de muchas especies vegetales ha siempre despertado el más vivo interés de naturalistas y médicos. Además, en todas las épocas, se ha exigido un buen conocimiento de la botánica médica de parte de quienes se destinaban a ejercer la medicina. Entre las plantas medicinales utilizadas por los antiguos pueblos del Anáhuac, se cita el yoloxóchitl o flor del corazón (Talauma mexicana) que, al parecer, tiene acción simildigitálica. Investigaciones de nuestro siglo han demostrado un efecto inotrópico positivo y bradicardizante del extracto de Magnolia grandiflora o Talauma mexicana. Desde fines del siglo XVIII se ha utilizado la digital, considerada inicialmente como un diurético y después como un cardiotónico. La acción de los glucósidos digitálicos sobre los tejidos cardiácos ha sido estudiada experimentalmente sobre todo en México. Hoy en día existen agentes inotrópicos positivos derivados de las piridinas, como la milrinona, que se emplean útilmente en la insuficiencia cardiaca refractaria. Pero, según la opinión de distinguidos farmacólogos, ® en el caso de le insuficiencia cardiaca asociada a fibrilación auricular, la digital resulta insustituible".

Historical perspectives on inotropic agents.

Although early experiments in animals and humans suggested that digitalis glycosides increased cardiac output only in the failing heart, later studies showed that these cardiotonic agents increase intraventricular systolic pressure and decrease relaxation time in the normal animal. The controversy concerning the peripheral vascular or direct cardiac effects of digitalis was finally resolved when new methods were applied to the study of the effects of this drug on intraventricular pressures and cardiac contractile force. Other positive inotropic agents, such as the adrenergic agonists, have also been tested for the treatment of heart failure. However, during long-term oral or intravenous therapy, the effectiveness of these drugs appears to diminish. Clinical studies of glucagon, a polypeptide with positive inotropic and chronotropic effects, have revealed its potential for causing side effects and its reduced activity in patients with chronic heart failure. With the discovery of several new types of inotropic agents, i.e., the bipyridines and the imidazole and benzimidazole derivatives, interest in revising our therapeutic approach to congestive heart failure has increased. This review discusses recent developments in this area.