Donor management is the key in the complex donation process,since up to 20%of organs of brain death donors(DBD)are lost due to hemodynamic instability.This challenge is made more difficult due to the lack of strong re...Donor management is the key in the complex donation process,since up to 20%of organs of brain death donors(DBD)are lost due to hemodynamic instability.This challenge is made more difficult due to the lack of strong recommendations on therapies for hemodynamic management in DBDs and more importantly to the epidemiologic changes in these donors who are becoming older and with more comorbidities(marginal donors).In the present manuscript we aimed at summarizing the available evidence on therapeutic strategies for hemodynamic management(focusing on vasoactive drugs)and monitoring(therapeutic goals).Evidence on management in elderly DBDs is also summarized.Donor management continues critical care but with different and specific therapeutic goals since the number of donor goals met is related to the number of organs retrieved and transplanted.Careful monitoring of selected parameters(possibly including serial echocardiography)is the clinical tool able to guarantee the achievement and maintaining of therapeutic goals.Despide worldwide differences,norepinephrine is the vasoactive of choice in most countries but,whenever higher doses(>0.2 mcg/kg/min)are needed,a second vasoactive drug(vasopressin)is advisable.Hormonal therapy(desmopressin,corticosteroid and thyroid hormone)are suggested in all DBDs independently of hemodynamic instability.In the single patient,therapeutic regimen(imprimis vasoactive drugs)should be chosen also according to the potential organs retrievable(i.e.heart vs liver and kidneys).展开更多
Background Owing to complex treatment,critically ill children may experience alterations in their vital parameters.We investigated whether such hemodynamic alterations were temporally and causally related to drug ther...Background Owing to complex treatment,critically ill children may experience alterations in their vital parameters.We investigated whether such hemodynamic alterations were temporally and causally related to drug therapy.Methods In a university pediatric intensive care unit,we retrospectively analyzed hemodynamic alterations defined as values exceeding the limits set for heart rate(HR)and blood pressure(BP).For causality assessment,we used the World Health Organization–Uppsala Monitoring Center(WHO–UMC)system,which categorizes the probability of causality as“certain,”“probable,”“possible,”and“unlikely.”Results Of 315 analyzed patients with 43,200 drug prescriptions,59.7%experienced at least one hemodynamic alteration;39.0%were affected by increased HR,19.0%by decreased HR,18.1%by increased BP,and 16.2%by decreased BP.According to drug information databases,83.9%of administered drugs potentially lead to hemodynamic alterations.Overall,88.3%of the observed hemodynamic alterations had a temporal relation to the administration of drugs;in 80.2%,more than one drug was involved.Based on the WHO–UMC system,a drug was rated as a“probable”causing factor for only 1.4%of hemodynamic alterations.For the remaining alterations,the probability ratings were lower because of multiple potential causes,e.g.,several drugs.Conclusions Critically ill children were frequently affected by hemodynamic alterations.The administration of drugs with potentially adverse effects on hemodynamic parameters is often temporally related to hemodynamic alterations.Hemodynamic alterations are often multifactorial,e.g.,due to administering multiple drugs in rapid succession;thus,the influence of individual drugs cannot easily be captured with the WHO–UMC system.展开更多
To explore the possibility of hydrogen sulfide (H 2S) as a messenger molecule in cardiovascular system, the authors discovered that H 2S (5×10 -5 -5×10 -4 mol·L -1 )exerted an effect on inhibiting endot...To explore the possibility of hydrogen sulfide (H 2S) as a messenger molecule in cardiovascular system, the authors discovered that H 2S (5×10 -5 -5×10 -4 mol·L -1 )exerted an effect on inhibiting endothelin 1 induced proliferation of cultured vascular smooth muscle cells (VSMCs) of rats in vitro . The 3H TdR incorporation decreased by 16.8%～37.4% in H 2S treated VSMCs as compared with the controls ( P <0.01). The inhibitory effect was found to be associated with reduced activity of MAPK. The authors also observed that endogenous H 2S levels markedly increased in vessels of rats with either endotoxic shock or septic shock [H 2S level (pmol·min -1 ·mg -1 ):tail artery (16.18±2.06) vs (8.12±0.55);mesenteric artery (10.17±1.11) vs (6.19 ±0.55);pulmonary artery(11.38±1.24) vs (5.27±0.51); aorta(6.21±0.48) vs (4.10± 0.28), P < 0.01 ]. The above findings suggested that H 2S might play an important role in the regulation of cardiovascular pathophysiologic events.展开更多
文摘Donor management is the key in the complex donation process,since up to 20%of organs of brain death donors(DBD)are lost due to hemodynamic instability.This challenge is made more difficult due to the lack of strong recommendations on therapies for hemodynamic management in DBDs and more importantly to the epidemiologic changes in these donors who are becoming older and with more comorbidities(marginal donors).In the present manuscript we aimed at summarizing the available evidence on therapeutic strategies for hemodynamic management(focusing on vasoactive drugs)and monitoring(therapeutic goals).Evidence on management in elderly DBDs is also summarized.Donor management continues critical care but with different and specific therapeutic goals since the number of donor goals met is related to the number of organs retrieved and transplanted.Careful monitoring of selected parameters(possibly including serial echocardiography)is the clinical tool able to guarantee the achievement and maintaining of therapeutic goals.Despide worldwide differences,norepinephrine is the vasoactive of choice in most countries but,whenever higher doses(>0.2 mcg/kg/min)are needed,a second vasoactive drug(vasopressin)is advisable.Hormonal therapy(desmopressin,corticosteroid and thyroid hormone)are suggested in all DBDs independently of hemodynamic instability.In the single patient,therapeutic regimen(imprimis vasoactive drugs)should be chosen also according to the potential organs retrievable(i.e.heart vs liver and kidneys).
文摘Background Owing to complex treatment,critically ill children may experience alterations in their vital parameters.We investigated whether such hemodynamic alterations were temporally and causally related to drug therapy.Methods In a university pediatric intensive care unit,we retrospectively analyzed hemodynamic alterations defined as values exceeding the limits set for heart rate(HR)and blood pressure(BP).For causality assessment,we used the World Health Organization–Uppsala Monitoring Center(WHO–UMC)system,which categorizes the probability of causality as“certain,”“probable,”“possible,”and“unlikely.”Results Of 315 analyzed patients with 43,200 drug prescriptions,59.7%experienced at least one hemodynamic alteration;39.0%were affected by increased HR,19.0%by decreased HR,18.1%by increased BP,and 16.2%by decreased BP.According to drug information databases,83.9%of administered drugs potentially lead to hemodynamic alterations.Overall,88.3%of the observed hemodynamic alterations had a temporal relation to the administration of drugs;in 80.2%,more than one drug was involved.Based on the WHO–UMC system,a drug was rated as a“probable”causing factor for only 1.4%of hemodynamic alterations.For the remaining alterations,the probability ratings were lower because of multiple potential causes,e.g.,several drugs.Conclusions Critically ill children were frequently affected by hemodynamic alterations.The administration of drugs with potentially adverse effects on hemodynamic parameters is often temporally related to hemodynamic alterations.Hemodynamic alterations are often multifactorial,e.g.,due to administering multiple drugs in rapid succession;thus,the influence of individual drugs cannot easily be captured with the WHO–UMC system.
文摘To explore the possibility of hydrogen sulfide (H 2S) as a messenger molecule in cardiovascular system, the authors discovered that H 2S (5×10 -5 -5×10 -4 mol·L -1 )exerted an effect on inhibiting endothelin 1 induced proliferation of cultured vascular smooth muscle cells (VSMCs) of rats in vitro . The 3H TdR incorporation decreased by 16.8%～37.4% in H 2S treated VSMCs as compared with the controls ( P <0.01). The inhibitory effect was found to be associated with reduced activity of MAPK. The authors also observed that endogenous H 2S levels markedly increased in vessels of rats with either endotoxic shock or septic shock [H 2S level (pmol·min -1 ·mg -1 ):tail artery (16.18±2.06) vs (8.12±0.55);mesenteric artery (10.17±1.11) vs (6.19 ±0.55);pulmonary artery(11.38±1.24) vs (5.27±0.51); aorta(6.21±0.48) vs (4.10± 0.28), P < 0.01 ]. The above findings suggested that H 2S might play an important role in the regulation of cardiovascular pathophysiologic events.
