Podcasts about vasopressor

In this episode of the Saving Lives Podcast, we discuss a study from Intensive Care Medicine that explores whether baseline serum chloride and pH affect outcomes with balanced fluids versus saline. The findings from the PLUS trial show no significant interaction, but intriguing trends suggest that hyperchloremic patients may benefit more from balanced fluids. The Vasopressor & Inotrope HandbookI have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: Ramanan M, Hammond N, Billot L, Delaney A, Devaux A, Finfer S, Li Q, Micallef S, Venkatesh B, Young PJ, Myburgh J; PLUS Investigators. Serum chloride concentration and outcomes in adults receiving intravenous fluid therapy with a balanced crystalloid solution or 0.9% sodium chloride. Intensive Care Med. 2025 Feb;51(2):249-258. doi: 10.1007/s00134-024-07764-2. Epub 2025 Feb 10. PMID: 39928118.

In this episode of the Saving Lives Podcast, we break down a randomized trial from CHEST (2025) comparing Normosol-R vs. Lactated Ringer's in critically ill adults. Learn whether acetate/gluconate-buffered fluids offer advantages over lactate-buffered solutions regarding acid-base balance, kidney function, and mortality. Tune in to hear how this study impacts critical care fluid management!The Vasopressor & Inotrope HandbookI have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: Qian ET, Brown RM, Jackson KE, Wang L, Stollings JL, Freundlich RE, Wanderer JP, Siew ED, Bernard GR, Self WH, Casey JD, Rice TW, Semler MW; Pragmatic Critical Care Research Group. Normosol-R versus Lactated Ringers in the Critically Ill: A Randomized Trial. Chest. 2025 Feb 17:S0012-3692(25)00165-5. doi: 10.1016/j.chest.2025.02.008. Epub ahead of print. PMID: 39971001.

In this episode of the Saving Lives Podcast, we review a 2025 study from Critical Care Medicine comparing lactated Ringer's and normal saline for initial fluid resuscitation in sepsis-induced hypotension. The findings suggest that LR may improve survival and increase hospital-free days compared to NS, supporting current guidelines favoring balanced crystalloids. Tune in for a deep dive into the study's results and clinical implications!The Vasopressor & Inotrope HandbookI have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: Gelbenegger G, Shapiro NI, Zeitlinger M, Jilma B, Douglas IS, Jorda A. Lactated Ringer's or Normal Saline for Initial Fluid Resuscitation in Sepsis-Induced Hypotension. Crit Care Med. 2025 Feb 19. doi: 10.1097/CCM.0000000000006601. Epub ahead of print. PMID: 39969246.

In this episode of the Saving Lives Podcast, we review a nationwide study on cardiogenic shock in general ICUs, recently published in the European Heart Journal: Acute Cardiovascular Care. Discover why non-ischemic heart failure now leads cardiogenic shock admissions, which patient groups face the highest mortality, and how early ICU intervention can improve outcomes. Stay tuned for critical insights into managing this high-risk population. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠ (Affiliate Link) My Store: ⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠ (Use "podcast" to save 10%) Citation: Citation: Guido T, Giovanni T, Elena G, Anna Z, Michele Z, Stefano F. Cardiogenic shock in general intensive care unit: a nationwide prospective analysis of epidemiology and outcome. Eur Heart J Acute Cardiovasc Care. 2024 Dec 3;13(11):768-778. doi: 10.1093/ehjacc/zuae108. PMID: 39302432.

Listener discretion is advised. References: Gutierrez, E. (2023). The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals. Hu W, Wang X, Su G. Infective endocarditis complicated by embolic events: Pathogenesis and predictors. Clin Cardiol. 2021 Mar;44(3):307-315. doi: 10.1002/clc.23554. Epub 2021 Feb 1. PMID: 33527443; PMCID: PMC7943911. Marik PE, Farkas JD. The Changing Paradigm of Sepsis: Early Diagnosis, Early Antibiotics, Early Pressors, and Early Adjuvant Treatment. Crit Care Med. 2018 Oct;46(10):1690-1692. doi: 10.1097/CCM.0000000000003310. PMID: 30216303.

In this episode of the Saving Lives Podcast, we explore a systematic review and meta-analysis from the Journal of Critical Care on sleep interventions in ICU patients. We learn about the effectiveness of pharmacologic and non-pharmacologic strategies in reducing delirium and discover how improving sleep could transform critical care outcomes. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠ (Affiliate Link) My Store: ⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠ (Use "podcast" to save 10%) Citation: Teng J, Qin H, Guo W, Liu J, Sun J, Zhang Z. Effectiveness of sleep interventions to reduce delirium in critically ill patients: A systematic review and meta-analysis. J Crit Care. 2023 Dec;78:154342. doi: 10.1016/j.jcrc.2023.154342. Epub 2023 Jun 9. PMID: 37302381.

In this episode of the Saving Lives Podcast, we dive into the latest research from CHEST, exploring how sepsis order sets can improve care value. Learn about the impact of these sets on reducing mortality, lowering hospital costs, and their role in streamlining sepsis management. Discover why order sets can be a game-changer for hospitals and society in addressing sepsis care. The Vasopressor & Inotrope HandbookI have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠https://amzn.to/47qJZe1⁠⁠ (Affiliate Link)My Store: ⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠ (Use "podcast" to save 10%) Citation: Dale CR, Chiu ST, Schoepflin Sanders S, Stowell CJ, Steel TL, Liao JM, Barnes JI. Sepsis Order Set Use Associated With Increased Care Value. Chest. 2024 Nov;166(5):1046-1055. doi: 10.1016/j.chest.2024.05.032. Epub 2024 Jun 19. PMID: 38906463; PMCID: PMC11638543. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode of the Saving Lives Podcast, Eddy Joe breaks down a study comparing continuous glucose monitoring systems (CGMS) to conventional point-of-care monitoring in ICU patients. Learn how CGMS improves glycemic control, reduces variability, and eases nursing workloads, even without reducing mortality. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠https://amzn.to/47qJZe1⁠ (Affiliate Link) My Store: ⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠ (Use "podcast" to save 10%) Citation: Chu C, Li J, Yang X, Zhao H, Wu Z, Xu R, Gao J. Continuous glucose monitoring versus conventional glucose monitoring in the ICU: A randomized controlled trial. J Crit Care. 2024 Dec;84:154894. doi: 10.1016/j.jcrc.2024.154894. Epub 2024 Aug 5. PMID: 39106581. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode of The Saving Lives Podcast, we explore Propofol Infusion Syndrome (PRIS), looking at this complication's incidence, laboratory, and clinical manifestations. Hat tip to the authors. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: https://amzn.to/47qJZe1 (Affiliate Link) My Store: https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook (Use "podcast" to save 10%) Citation: Li WK, Chen XJC, Altshuler D, Islam S, Spiegler P, Emerson L, Bender M. The incidence of propofol infusion syndrome in critically-ill patients. J Crit Care. 2022 Oct;71:154098. doi: 10.1016/j.jcrc.2022.154098. Epub 2022 Jun 17. PMID: 35724444. @eddyjoemd is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com Although great care has been taken to ensure that the information in this post is accurate, eddyjoemd, LLC shall not be held responsible or in any way liable for the continued accuracy of the information or for any errors, omissions, or inaccuracies or for any consequences arising therefrom. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode, we discuss recent findings on the potential risks of left atrial appendage closure (LAAC) in cardiac surgery patients without prior atrial fibrillation. The study highlights an increased risk of new-onset postoperative AF and prolonged hospital stays without clear benefits in mortality or stroke prevention. The Vasopressor & Inotrope HandbookAmazon: ⁠⁠https://amzn.to/3UvFFVf⁠⁠ (affiliate link) Signed Copy: ⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠ Movember Link: ⁠https://movember.com/m/eddyjoemd?mc=1⁠ Citation: Shuhaiber JH, Abbas M, Morland T, Kirchner HL, El-Manzalawy Y. Atrial appendage closure is associated with increased risk for postoperative atrial fibrillation. J Cardiothorac Surg. 2024 Nov 2;19(1):619. doi: 10.1186/s13019-024-03119-6. PMID: 39488696. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode of the Saving Lives Podcast, Eddy Joe explores the TRISCEND II trial's groundbreaking findings on transcatheter tricuspid valve replacement (TTVR) for severe tricuspid regurgitation. Learn about the quality-of-life improvements, procedural risks, and future directions for this innovative therapy. The Vasopressor & Inotrope HandbookAmazon: https://amzn.to/3UvFFVf (affiliate link) Signed Copy: https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook Citation: https://www.nejm.org/doi/full/10.1056/NEJMoa2401918 --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode of the Saving Lives Podcast, we dive into the DecatSepsis trial, exploring the role of dexmedetomidine in reducing mortality and managing septic shock. Discover how this sedative could help mitigate the harmful effects of the hyperadrenergic state in septic patients. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. If you're in the US, you can order ⁠⁠A SIGNED & PERSONALIZED COPY for $29.99⁠⁠ or via ⁠⁠AMAZON for $32.99⁠⁠ (for orders in or outside the US). Ebook versions are available via ⁠⁠AMAZON KINDLE for $9.99⁠⁠, ⁠⁠APPLE BOOKS⁠⁠, and ⁠⁠GOOGLE PLAY⁠⁠. ¡Excelentes noticias! Mi libro ha sido traducido al español y está disponible a traves de ⁠⁠AMAZON⁠⁠. Las versiones electrónicas están disponibles para su compra for solo $9.99 en ⁠⁠AMAZON KINDLE⁠⁠, ⁠⁠APPLE BOOKS⁠⁠ y ⁠⁠GOOGLE PLAY⁠⁠. Citation Ezz Al-Regal AR, Ramzy EA, Allah Atia AA, Emara MM. Dexmedetomidine for Reducing Mortality in Patients With Septic Shock A Randomized Controlled Trial (DecatSepsis). Chest. 2024 Jul 14:S0012-3692(24)04601-4. doi: 10.1016/j.chest.2024.06.3794. Epub ahead of print. PMID: 39004217. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode of the Saving Lives Podcast, we discuss a recent randomized controlled trial exploring the use of minocycline to prevent delirium in critically ill patients. The study reveals that minocycline may significantly reduce delirium incidence and hospital mortality, offering a promising new pharmacologic approach. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. If you're in the US, you can order ⁠A SIGNED & PERSONALIZED COPY for $29.99⁠ or via ⁠AMAZON for $32.99⁠ (for orders in or outside the US). Ebook versions are available via ⁠AMAZON KINDLE for $9.99⁠, ⁠APPLE BOOKS⁠, and ⁠GOOGLE PLAY⁠. ¡Excelentes noticias! Mi libro ha sido traducido al español y está disponible a traves de ⁠AMAZON⁠. Las versiones electrónicas están disponibles para su compra for solo $9.99 en ⁠AMAZON KINDLE⁠, ⁠APPLE BOOKS⁠ y ⁠GOOGLE PLAY⁠. Citation Dal-Pizzol F, Coelho A, Simon CS, Michels M, Corneo E, Jeremias A, Damásio D, Ritter C. Prophylactic Minocycline for Delirium in Critically Ill Patients: A Randomized Controlled Trial. Chest. 2024 May;165(5):1129-1138. doi: 10.1016/j.chest.2023.11.041. Epub 2023 Dec 1. PMID: 38043911. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode of the Saving Lives Podcast, Eddy Joe delves into the latest research comparing balanced electrolyte solutions to 0.9% saline for treating diabetic ketoacidosis (DKA). Discover how BES could potentially revolutionize DKA management by speeding up recovery and reducing complications. Tune in for an in-depth analysis of the study and its implications for clinical practice. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. If you're in the US, you can order A SIGNED & PERSONALIZED COPY for $29.99 or via AMAZON for $32.99 (for orders in or outside the US). Ebook versions are available via AMAZON KINDLE for $9.99, APPLE BOOKS, and GOOGLE PLAY. ¡Excelentes noticias! Mi libro ha sido traducido al español y está disponible a traves de AMAZON. Las versiones electrónicas están disponibles para su compra for solo $9.99 en AMAZON KINDLE, APPLE BOOKS y GOOGLE PLAY. Citation: Szabó GV, Szigetváry C, Turan C, Engh MA, Terebessy T, Fazekas A, Farkas N, Hegyi P, Molnár Z. Fluid resuscitation with balanced electrolyte solutions results in faster resolution of diabetic ketoacidosis than with 0.9% saline in adults - A systematic review and meta-analysis. Diabetes Metab Res Rev. 2024 Jul;40(5):e3831. doi: 10.1002/dmrr.3831. PMID: 38925619. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

Show notes at pharmacyjoe.com/episode935. In this episode, I'll discuss an article about which vasopressor is best in early traumatic brain injury patients. The post 935: What vasopressor is best to use in traumatic brain injury? appeared first on Pharmacy Joe.

In this episode, Eddy Joe delves into the intensive care management of brain-dead donors, based on a recent article from Intensive Care Medicine. Learn about hemodynamic support, endocrine treatment, and respiratory management strategies to optimize organ procurement. Tune in for an in-depth discussion on improving donor organ viability while maintaining the dignity of the deceased. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy while supporting my endeavors. If you're in the US, you can order ⁠⁠⁠A SIGNED & PERSONALIZED COPY for $29.99⁠⁠⁠ or via ⁠⁠⁠AMAZON⁠⁠⁠ (for orders outside the US). Ebook versions: ⁠⁠⁠AMAZON KINDLE for $9.9⁠⁠⁠⁠⁠⁠9⁠⁠⁠. ⁠⁠⁠APPLE BOOKS⁠⁠⁠ and ⁠⁠⁠GOOGLE PLAY⁠⁠⁠.  ¡Excelentes noticias! Mi libro ha sido traducido al español y las versiones electrónicas están disponibles para su compra for solo $9.99 en ⁠⁠⁠AMAZON KINDLE⁠⁠⁠, ⁠⁠⁠APPLE BOOKS⁠⁠⁠ y ⁠⁠⁠GOOGLE PLAY⁠⁠⁠. When you use these affiliate links, I earn an additional commission at no extra cost to you, which is a great way to support my work. Citation: Gunst J, Souter MJ. Management of the brain-dead donor in the intensive care unit. Intensive Care Med. 2024 Jun;50(6):964-967. doi: 10.1007/s00134-024-07409-4. Epub 2024 Apr 10. PMID: 38598128. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode of the Saving Lives Podcast, we dive into a groundbreaking 2017 study comparing vasopressin and norepinephrine for treating vasoplegic shock after cardiac surgery. Discover the study's compelling results, how vasopressin outperformed norepinephrine in reducing severe complications, and the potential implications for clinical practice. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy while supporting my endeavors. If you're in the US, you can order ⁠⁠⁠A SIGNED & PERSONALIZED COPY for $29.99⁠⁠⁠ or via ⁠⁠⁠AMAZON⁠⁠⁠ (for orders outside the US). Ebook versions: ⁠⁠⁠AMAZON KINDLE for $9.9⁠⁠⁠⁠⁠⁠9⁠⁠⁠. ⁠⁠⁠APPLE BOOKS⁠⁠⁠ and ⁠⁠⁠GOOGLE PLAY⁠⁠⁠.  ¡Excelentes noticias! Mi libro ha sido traducido al español y está disponible a traves de AMAZON. Las versiones electrónicas están disponibles para su compra for solo $9.99 en AMAZON KINDLE, APPLE BOOKS y GOOGLE PLAY. When you use these affiliate links, I earn an additional commission at no extra cost to you, which is a great way to support my work. Citation: Hajjar LA, Vincent JL, Barbosa Gomes Galas FR, Rhodes A, Landoni G, Osawa EA, Melo RR, Sundin MR, Grande SM, Gaiotto FA, Pomerantzeff PM, Dallan LO, Franco RA, Nakamura RE, Lisboa LA, de Almeida JP, Gerent AM, Souza DH, Gaiane MA, Fukushima JT, Park CL, Zambolim C, Rocha Ferreira GS, Strabelli TM, Fernandes FL, Camara L, Zeferino S, Santos VG, Piccioni MA, Jatene FB, Costa Auler JO Jr, Filho RK. Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery: The VANCS Randomized Controlled Trial. Anesthesiology. 2017 Jan;126(1):85-93. doi: 10.1097/ALN.0000000000001434. PMID: 27841822. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode of the Saving Lives Podcast, we discuss the comprehensive review of frailty assessment tools in critically ill older adults. Learn about the Clinical Frailty Scale and how these tools can influence clinical practice and patient outcomes. Tune in for insights on improving care for the elderly in ICU settings. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy while supporting my endeavors. If you're in the US, you can order ⁠⁠A SIGNED & PERSONALIZED COPY for $29.99⁠⁠ or via ⁠⁠AMAZON⁠⁠ (for orders outside the US). Ebook versions: ⁠⁠AMAZON KINDLE for $9.9⁠⁠⁠⁠9⁠⁠. ⁠⁠APPLE BOOKS⁠⁠ and ⁠⁠GOOGLE PLAY⁠⁠.  ¡Excelentes noticias! Mi libro ha sido traducido al español y las versiones electrónicas están disponibles para su compra for solo $9.99 en ⁠⁠AMAZON KINDLE⁠⁠, ⁠⁠APPLE BOOKS⁠⁠ y ⁠⁠GOOGLE PLAY⁠⁠. When you use these affiliate links, I earn an additional commission at no extra cost to you, which is a great way to support my work. CITATION: Moïsi L, Mino JC, Guidet B, Vallet H. Frailty assessment in critically ill older adults: a narrative review. Ann Intensive Care. 2024 Jun 18;14(1):93. doi: 10.1186/s13613-024-01315-0. PMID: 38888743. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy while supporting my endeavors. If you're in the US, you can order ⁠A SIGNED & PERSONALIZED COPY for $29.99⁠ or via ⁠AMAZON⁠ (for orders outside the US). Ebook versions: ⁠AMAZON KINDLE for $9.9⁠⁠9⁠. ⁠APPLE BOOKS⁠ and ⁠GOOGLE PLAY⁠.  ¡Excelentes noticias! Mi libro ha sido traducido al español y las versiones electrónicas están disponibles para su compra for solo $9.99 en ⁠AMAZON KINDLE⁠, ⁠APPLE BOOKS⁠ y ⁠GOOGLE PLAY⁠. When you use these affiliate links, I earn an additional commission at no extra cost to you, which is a great way to support my work. Citation: Choi HR, Ho MH, Lin CC. Navigating tensions when life-sustaining treatment is withdrawn: A thematic synthesis of nurses' and physicians' experiences. J Clin Nurs. 2024 Jun;33(6):2337-2356. doi: 10.1111/jocn.17059. Epub 2024 Feb 7. PMID: 38323726. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

What are the outcomes in patients who suffer in-hospital cardiac arrest based on the duration of the code? This podcast episode covers a retrospective cohort study that analyzed this. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy while supporting my endeavors. If you're in the US, you can order A SIGNED & PERSONALIZED COPY for $29.99 or via AMAZON (for orders outside the US). Ebook versions: AMAZON KINDLE for $9.99. APPLE BOOKS and GOOGLE PLAY. ¡Excelentes noticias! Mi libro ha sido traducido al español y las versiones electrónicas están disponibles para su compra for solo $9.99 en AMAZON KINDLE, APPLE BOOKS y GOOGLE PLAY.When you use these affiliate links, I earn an additional commission at no extra cost to you, which is a great way to support my work. Citation: Okubo M, Komukai S, Andersen LW, Berg RA, Kurz MC, Morrison LJ, Callaway CW; American Heart Association's Get With The Guidelines—Resuscitation Investigators. Duration of cardiopulmonary resuscitation and outcomes for adults with in-hospital cardiac arrest: retrospective cohort study. BMJ. 2024 Feb 7;384:e076019. doi: 10.1136/bmj-2023-076019. Erratum in: BMJ. 2024 Apr 18;385:q900. PMID: 38325874; PMCID: PMC10847985. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

Show notes at pharmacyjoe.com/episode928. In this episode, I’ll discuss what vasopressor to use in post-resuscitation shock. The post 928: What is the best vasopressor to use in post-resuscitation shock? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode923. In this episode, I’ll discuss if phentolamine the only thing you can use for vasopressor extravasation. The post 923: Is phentolamine the only thing you can use for vasopressor extravasation? appeared first on Pharmacy Joe.

In this episode of The Saving Lives Podcast, we delve into the intricate subject of advance directives in the intensive care setting. Titled "Deciphering the Complex World of Advance Directives in ICU Care: Challenges and Solutions," the episode explores the historical background, implementation challenges, and the impact of advance directives on patient care within ICUs. Let's highlight the practical difficulties healthcare professionals face in honoring patients' wishes and the varied effectiveness of advance directives across different regions. This episode aims to shed light on the importance of advance directives in ensuring patient autonomy and improving the quality of end-of-life care in critical settings. The Vasopressor & Inotrope Handbook: ⁠⁠⁠⁠⁠Amazon Affiliate Link⁠⁠⁠⁠⁠ (I will earn an extra small commission) and ⁠⁠⁠⁠⁠Signed/Personalized Copies⁠⁠⁠⁠⁠. Citation: Baumann SM, Kruse NJ, Kliem PSC, Amacher SA, Hunziker S, Dittrich TD, Renetseder F, Grzonka P, Sutter R. Translation of patients' advance directives in intensive care units: are we there yet? J Intensive Care. 2023 Nov 15;11(1):53. doi: 10.1186/s40560-023-00705-z. PMID: 37968692; PMCID: PMC10648602. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode of The Saving Lives Podcast, we explore the innovative MitraClip system, a less invasive treatment for mitral regurgitation. The discussion covers the device's evolution, its impact on patient outcomes, and the challenges and complications associated with its use. The Vasopressor & Inotrope Handbook: ⁠⁠⁠⁠⁠Amazon Affiliate Link⁠⁠⁠⁠⁠ (I will earn an extra small commission) and ⁠⁠⁠⁠⁠Signed/Personalized Copies⁠⁠⁠⁠⁠. Citation: Schnitzler K, Hell M, Geyer M, Kreidel F, Münzel T, von Bardeleben RS. Complications Following MitraClip Implantation. Curr Cardiol Rep. 2021 Aug 13;23(9):131. doi: 10.1007/s11886-021-01553-9. PMID: 34387748; PMCID: PMC8363549. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode of The Saving Lives Podcast, we delve into the compelling findings of a recent review on the adverse effects of physical restraint use in ICUs. We discuss the paradoxical nature of restraints, designed for patient safety but linked to significant complications, including skin injuries, delirium, PTSD, and more. Understanding the limitations of our current system, we explore how this research urges a shift towards more compassionate, patient-centered care and the critical need for alternative practices. The Vasopressor & Inotrope Handbook: ⁠⁠⁠⁠⁠Amazon Affiliate Link⁠⁠⁠⁠⁠ (I will earn an extra small commission) and ⁠⁠⁠⁠⁠Signed/Personalized Copies⁠⁠⁠⁠⁠. CLICK HERE for the Instagram Post Citation: Sebastian Berger, Pascale Grzonka, Simon A. Amacher, Sabina Hunziker, Anja I. Frei, Raoul Sutter, Adverse events related to physical restraint use in intensive care units: A review of the literature, Journal of Intensive Medicine, 2023,ISSN 2667-100X, --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode of The Saving Lives Podcast, we dive into a compelling study from the Annals of Intensive Care, exploring the prevalence and impact of hyperdynamic left ventricular systolic function in septic patients. Unpacking the findings, we discuss how this condition influences mortality rates and what it means for clinical practice in intensive care units. The Vasopressor & Inotrope Handbook: ⁠⁠⁠⁠⁠Amazon Affiliate Link⁠⁠⁠⁠⁠ (I will earn an extra small commission) and ⁠⁠⁠⁠⁠Signed/Personalized Copies⁠⁠⁠⁠⁠. Citation: Sato R, Sanfilippo F, Hasegawa D, Prasitlumkum N, Duggal A, Dugar S. Prevalence and prognosis of hyperdynamic left ventricular systolic function in septic patients: a systematic review and meta-analysis. Ann Intensive Care. 2024 Feb 3;14(1):22. doi: 10.1186/s13613-024-01255-9. PMID: 38308701. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

This episode delves into the 2024 update on corticosteroid guidelines for critically ill patients with sepsis, ARDS, and community-acquired pneumonia. We break down the recommendations, evidence, and clinical implications of this crucial guidance for healthcare providers. The Vasopressor & Inotrope Handbook: ⁠⁠⁠⁠Amazon Affiliate Link⁠⁠⁠⁠ (I will earn an extra small commission) and ⁠⁠⁠⁠Signed/Personalized Copies⁠⁠⁠⁠. Citation: Chaudhuri D, Nei AM, Rochwerg B, Balk RA, Asehnoune K, Cadena RS, Carcillo JA, Correa R, Drover K, Esper AM, Gershengorn HB, Hammond NE, Jayaprakash N, Menon K, Nazer L, Pitre T, Qasim ZA, Russell JA, Santos AP, Sarwal A, Spencer-Segal J, Tilouche N, Annane D, Pastores SM. Executive Summary: Guidelines on Use of Corticosteroids in Critically Ill Patients With Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia Focused Update 2024. Crit Care Med. 2024 Jan 19. doi: 10.1097/CCM.0000000000006171. Epub ahead of print. PMID: 38240490. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

Elizabeth Munroe, MD, MSc is a clinical instructor and post-doctoral research fellow in the dvision of Pulmonary and Critical Care Medicine at the University of Michigan. Hayley Gershengorn, MD, FCCM, ATSF is a professor of clinical medicine in the Division of Pulmonary, Critical Care, and Sleep Medicine at the University ...

In this episode, we delve into the groundbreaking study "Influence of therapeutic plasma exchange treatment on short-term mortality of critically ill adult patients with sepsis-induced organ dysfunction." We explore how Therapeutic Plasma Exchange (TPE) could revolutionize the treatment of sepsis, a condition notoriously difficult to manage. The episode breaks down the study's methods, results, and significant implications for future clinical practice, highlighting the urgent need for further research in this promising area. The Vasopressor & Inotrope Handbook: ⁠⁠⁠Amazon Affiliate Link⁠⁠⁠ (I will earn an extra small commission) and ⁠⁠⁠Signed/Personalized Copies⁠⁠⁠. Citation: Kuklin V, Sovershaev M, Bjerner J, Keith P, Scott LK, Thomas OMT, Szpirt W, Rock G, Stegmayr B. Influence of therapeutic plasma exchange treatment on short-term mortality of critically ill adult patients with sepsis-induced organ dysfunction: a systematic review and meta-analysis. Crit Care. 2024 Jan 4;28(1):12. doi: 10.1186/s13054-023-04795-x. PMID: 38178170; PMCID: PMC10768220. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode of The Saving Lives Podcast, "Integrating Palliative Care in the ICU: Enhancing Quality of Life," host EddyJoe discusses the article 'Palliative Care in Intensive Care' from 'Intensive Care Medicine.' The episode examines how palliative care improves patient quality of life and reduces ICU stays, highlighting its role beyond end-of-life care. It emphasizes the need for training and changing perceptions among healthcare professionals. Essential for medical practitioners, this episode offers insights into incorporating palliative care into ICU practices for better patient outcomes. The Vasopressor & Inotrope Handbook: ⁠⁠Amazon Affiliate Link⁠⁠ (I will earn an extra small commission) and ⁠⁠Signed Copies⁠⁠. TrueLearn Link: ⁠⁠⁠⁠⁠⁠⁠⁠https://truelearn.referralrock.com/l/EDDYJOEMD25/⁠⁠⁠⁠⁠⁠⁠⁠ Discount code: EDDYJOEMD25 Citation: Neukirchen M, Metaxa V, Schaefer MS. Palliative care in intensive care. Intensive Care Med. 2023 Dec;49(12):1538-1540. doi: 10.1007/s00134-023-07260-z. Epub 2023 Nov 27. PMID: 38010381; PMCID: PMC10709230. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

In this episode, we delve into the groundbreaking DAMIS trial, exploring the impact of sublingual microcirculation assessment on treatment decisions for ICU patients with shock. We discuss the methodology, findings, and implications of this extensive multicenter study, offering insights into how real-time microcirculatory data influences clinical outcomes in critical care. Join us for an in-depth analysis and expert opinions on this pivotal topic in intensive care medicine. Show Notes: https://eddyjoemd.com/damis-trial-microcirculation/ The Vasopressor & Inotrope Handbook: ⁠Amazon Affiliate Link⁠ (I will earn an extra small commission) and ⁠Signed Copies⁠. Citation: Bruno RR, Wollborn J, Fengler K, Flick M, Wunder C, Allgäuer S, Thiele H, Schemmelmann M, Hornemann J, Moecke HME, Demirtas F, Palici L, Franz M, Saugel B, Kattan E, De Backer D, Bakker J, Hernandez G, Kelm M, Jung C. Direct assessment of microcirculation in shock: a randomized-controlled multicenter study. Intensive Care Med. 2023 Jun;49(6):645-655. doi: 10.1007/s00134-023-07098-5. Epub 2023 Jun 6. Erratum in: Intensive Care Med. 2023 Oct;49(10):1279. PMID: 37278760; PMCID: PMC10242221. This Podcast was edited using Descript: ⁠⁠⁠⁠⁠https://www.descript.com?lmref=BGOxjQ⁠⁠⁠⁠ --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

The Vasopressor & Inotrope Handbook: Amazon Affiliate Link (I will earn an extra small commission) and Signed Copies. Show Notes: eddyjoemd.com/asymptomatic-catheter-related-thrombosis/ Explore the often-overlooked issue of asymptomatic catheter-related thrombosis (CRT) in ICU patients on The Saving Lives Podcast. This episode delves into a revealing study published in the Annals of Intensive Care, uncovering the incidence, risk factors, and implications of asymptomatic CRT. Join us for a thought-provoking discussion that challenges traditional beliefs and sheds light on crucial aspects of catheter management in critical care. TrueLearn Link: ⁠⁠⁠⁠⁠⁠⁠https://truelearn.referralrock.com/l/EDDYJOEMD25/⁠⁠⁠⁠⁠⁠⁠ Discount code: EDDYJOEMD25 This Podcast was edited using Descript: ⁠⁠⁠⁠https://www.descript.com?lmref=BGOxjQ⁠⁠⁠⁠ Citation: Abbruzzese C, Guzzardella A, Consonni D, Turconi G, Bonetti C, Brioni M, Panigada M, Grasselli G. Incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study. Ann Intensive Care. 2023 Oct 19;13(1):106. doi: 10.1186/s13613-023-01206-w. PMID: 37858003; PMCID: PMC10587047. Link to Article --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

Roger Seheult, MD of MedCram explains what the vasopressor trap is, and how to get out of it. See all Dr. Seheult's videos at: https://www.medcram.com (This video was recorded on March 22, 2023) Roger Seheult, MD is the co-founder and lead professor at https://www.medcram.com He is Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine and an Associate Professor at the University of California, Riverside School of Medicine. MEDCRAM WORKS WITH MEDICAL PROGRAMS AND HOSPITALS: MedCram offers group discounts for students and medical programs, hospitals, and other institutions. Contact us at customers@medcram.com if you are interested. MEDIA CONTACT: Media Contact: customers@medcram.com Media contact info: https://www.medcram.com/pages/media-contact Video Produced by Kyle Allred FOLLOW US ON SOCIAL MEDIA: https://www.facebook.com/MedCram https://twitter.com/MedCramVideos https://www.instagram.com/medcram DISCLAIMER: MedCram medical videos are for medical education and exam preparation, and NOT intended to replace recommendations from your doctor. #vasopressor #ultrasound #ekg  

In this episode, we're going to continue discussing our crisis checklists and the ones that relate to distributive shock specifically. Let's talk about what happens during neurogenic shock by discussing a case involving a 34-year-old male that came into the ER after a motor vehicle crash. We'll talk about what you should do if you face this scenario and lay out the checklist to help prioritize care for this patient.   Here are some of the things you'll learn on this show: The details for today's case study and how to set priorities. (3:00) Pathophysiology of neurogenic shock. (6:28) The signs and symptoms that come along with this. (9:43) Breaking down the treatment needed. (13:45) Things to be worried about. (17:26) Vasopressor support, (21:15) Differential diagnoses we should be considering. (26:50)   About our hosts: https://kpatprogram.org/about-the-school/faculty.html  Visit us online: http://beyondthemaskpodcast.com  Get the CE certificate here: https://beyondthemaskpodcast.com/wp-content/uploads/2020/04/Beyond-the-Mask-CE-Cert-FILLABLE.pdf

On this month's NCS Podcast Series episode, Kassi Kronfeld interviews Dr. Vijay Kroshnamoorthy on his recent article, “Association of Vasopressor Choice with Clinical and Functional Outcomes Following Moderate to Severe Traumatic Brain Injury: A TRACK-TBI Study.” The NCS Podcast is the official podcast of the Neurocritical Care Society. Our senior producer is Bonnie Rossow. Our host is Fawaz Almufti, and our production staff includes Tareq Saad Almaghrabi, Andrew Bauerschmidt, Leonid Groysman, Atul Kalanuria, Lauren Koffman, Kassi Kronfeld, Holly Ledyard, Lindsay Marchetti, Alexandra Reynolds, Lucia Rivera Lara, Jon Rosenberg, Jason Siegel, Zachary Threlkeld, Teddy Youn, and Chris Zammit. Our administrative staff includes Bonnie Rossow. Music by Mohan Kottapally.

Show notes at pharmacyjoe.com/episode719. In this episode, I'll discuss the feasibility of peripheral vasopressors. The post 719: Peripheral Vasopressor Feasibility appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode719. In this episode, I ll discuss the feasibility of peripheral vasopressors. The post 719: Peripheral Vasopressor Feasibility appeared first on Pharmacy Joe.

Article discussed in this episode:Liberation from Invasive Mechanical Ventilation with Continued Receipt of Vasopressor Infusions 

Show notes at pharmacyjoe.com/episode694. In this episode, I'll discuss an article about which vasopressor is best in early traumatic brain injury patients. The post 694: What vasopressor is best to use in traumatic brain injury? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode694. In this episode, I ll discuss an article about which vasopressor is best in early traumatic brain injury patients. The post Episode 694: What vasopressor is best to use in traumatic brain injury? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode689. In this episode, I’ll discuss what vasopressor to use in post-resuscitation shock. The post 689: What is the best vasopressor to use in post-resuscitation shock? appeared first on Pharmacy Joe.

Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com One vasopressor to rule them all! Let's break down this ACEP PEER question that tells us what the ultimate pressor is in certain patients.

Show notes at pharmacyjoe.com/episode689. In this episode, I’ll discuss what vasopressor to use in post-resuscitation shock. The post 689: What is the best vasopressor to use in post-resuscitation shock? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode683. In this episode, I’ll discuss if phentolamine the only thing you can use for vasopressor extravasation. The post 683: Is phentolamine the only thing you can use for vasopressor extravasation? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode683. In this episode, I’ll discuss if phentolamine the only thing you can use for vasopressor extravasation. The post 683: Is phentolamine the only thing you can use for vasopressor extravasation? appeared first on Pharmacy Joe.

In this episode, we are talking about vasopressors and inotropes in Anaesthesia. The information and detail provided here are for residents and junior registrars starting in their first few months of Anaesthesia. There is a lot more detail to know for the Primary Exam, but this will give you a good starting point to perform at your best when starting out.A lot of useful information can be gathered from this textbook:Pharmacology for Anaesthesia and Intensive Care 5th Editionhttps://amzn.to/3u3xqS1https://amzn.to/3ACOwbIAll opinions expressed here are our own, and based on our experiences, and are not reflective of our employers or our associated training programs.Please refer to ANZCA, hospital and training network-specific documents and information for the most up to date information and guidance on the application process.If you have any questions, please email anaesthesiapodcast@gmail.com-------------------------------------------------------------------------------------------------------Please rate, post a review and subscribe!Check out https://anaesthesiacollective.com/ for more useful informationandsign up to the ABCs of Anaesthesia facebook group https://www.facebook.com/groups/2082807131964430and check out the ABCs of Anaesthesia YouTube channel for more contenthttps://www.youtube.com/c/ABCsofAnaesthesiaDisclaimer:The information contained in this podcast is for medical practitioner education only. It is not and will not be relevant for the general public.This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such.The medical information is provided “as is” without any representations or warranties, express or implied.The presenter makes no representations or warranties in relation to the medical information on this episode.You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant.You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode'Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewingThe information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia.The information presented here does not represent the views of any hospital or ANZCA.These podcasts are solely for the training and education of medical practitioners and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements.This disclaimer was created based on a Contractology template available at http://www.contractology.com.

Vasoactives in Septic Shock Part II Special Guest: Patrick M. Wieruszewski, Pharm.D., BCCCP   Reference List: https://pharmacytodose.files.wordpress.com/2021/12/vasoactives-in-septic-shock-ii-references.pdf   02:51 – Background into vasodilatory shock and its outcomes; 04:14 – Signs/symptoms of septic shock; 05:09 – Norepinephrine as first-line vasopressor; 09:05 – Using second-line vasopressors; 17:04 – Human physiology and hemodynamics; 21:02 – More important: time to treatment or vasopressor choice; 22:16 – Taking biomarkers/genetic markers from the research lab to clinical practice; 28:22 – Vasopressin use in septic shock; 43:14 – Angiotensin II updates; 66:00 – Epinephrine in septic shock; 69:32 – Vasopressor stewardship; 72:40 – One wish for septic shock management   PharmacyToDose.Com @PharmacyToDose on Twitter PharmacyToDose@Gmail.com

Show notes at pharmacyjoe.com/episode655. In this episode, I’ll discuss 4 changes to vasopressor recommendations in the 2021 Sepsis Guidelines. The post 655: Four changes to vasopressor recommendations in the 2021 Sepsis Guidelines appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode655. In this episode, I’ll discuss 4 changes to vasopressor recommendations in the 2021 Sepsis Guidelines. The post 655: Four changes to vasopressor recommendations in the 2021 Sepsis Guidelines appeared first on Pharmacy Joe.

Moderator: James Rathmell, M.D. Participants: Alexandre Joosten, M.D., Ph.D. and editorialist David A. Story, M.D., F.A.N.Z.C.A. Articles Discussed: Computer-assisted Individualized Hemodynamic Management Reduces Intraoperative Hypotension in Intermediate- and High-risk Surgery: A Randomized Controlled Trial Computer-assisted Anesthesia Care: Avoiding the Highway to HAL

Listen to the Q&A between Prof. Manu Malbrain and author Prof Aarne Feldheiser on his article “Vasopressor effects on venous return in septic patients: a review” and discover further insights in this recent EJA article. You can find the two publications mentioned Here: 1) Simon Gelman: A physiological story of venous return (https://pubmed.ncbi.nlm.nih.gov/18362606/) 2) Aarne Feldheiser: Oesophageal Doppler and calibrated pulse contour analysis are not interchangeable within a goal-directed haemodynamic algorithm in major gynaecological surgery (https://pubmed.ncbi.nlm.nih.gov/25107544/)

In this month's EM Quick Hits podcast: Anand Swaminathan on vasopressor failure, Brit Long and Michael Gottlieb on aspleic considerations, Sarah Reid on a bronchiolitis update and evolving patterns in the COVID era, Hans Rosenberg and Lindsay Cheskes on ICD electrical storm, Justin Morgenstern on night shift tips... The post EM Quick Hits 29 Vasopressor Failure, Asplenic Considerations, Bronchiolitis Update, ICD Electrical Storm, Night Shift Tips appeared first on Emergency Medicine Cases.

A randomized, multicenter, international, double-blind, placebo-controlled trial conducted to determine whether the addition of midodrine to standard care reduces the time to discontinuation of IV vasopressor use in otherwise resuscitated patients

Natalie Haddad, Pharm.D. (@NatalieHaddadRx) explains the mechanism of action of midodrine, reviews the current evidence for midodrine and its impact on vasopressor discontinuation and identifies midodrine’s role in therapy for vasopressor discontinuation.For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes or the host, Garrett E. Schramm, Pharm.D., @garrett_schramm on Twitter!You can also connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

No episódio de hoje o médico anestesista Francisco Neto compartilha algumas dicas fundamentais que permitem o uso da NORADRENALINA como vasopressor de resgate. Aproveite!

Kontakt: ivajuntan@gmail.com       Musik: Blind Love Dub by Jeris (c) copyright 2017 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/VJ_Memes/55416 Ft: Kara Square (mindmapthat)       Om du gillar du det vi gör - stöd Life Support Foundation! www.lifesupportfoundation.org     Bli månadsgivare eller använd Swish: 1234610804    Dagens artikel: Li Y, Li H, Zhang D. Timing of norepinephrine initiation in patients with septic shock: a systematic review and meta-analysis. Crit Care. 2020 Aug 6;24(1):488. doi: 10.1186/s13054-020-03204-x. PMID: 32762765; PMCID: PMC7409707. See omnystudio.com/listener for privacy information.

In this episode of Critical Matters, we will discuss hypotension and new data on Angiotensin II within the context of our path towards personalized vasopressor support. Our guest is Dr. Ashish K. Khanna. Dr. Khanna is an anesthesia and critical care practicing physician. He is Associate Professor, and Section Head for Research, in the Department of Anesthesiology, Section on Critical Care Medicine of the Wake Forest School of Medicine, in Winston-Salem, North Carolina. He is a prolific author and researcher and was the lead author of the ATHOS-3 study in the New England Journal of Medicine. The results of which led to the approval of Angiotensin II as a vasopressor for the treatment of refractory hypotension in adults with septic or other types of distributive shock. Links: The Relationship Between ICU Hypotension and In-Hospital Mortality and Morbidity in Septic Patients: https://bit.ly/2D1epJQ Association between Mean Arterial Pressure and Acute Kidney Injury and a Composite of Myocardial Injury and Mortality in Postoperative Critically Ill Patients: A Retrospective Cohort Analysis: https://bit.ly/2QuyStz Angiotensin II for the Treatment of Vasodilatory Shock (ATHOS-3 Trial): https://bit.ly/2G27hhB Survival After Shock Requiring High-Dose Vasopressor Therapy: https://bit.ly/2EkLm4P Renin as a Marker of Tissue-Perfusion and Prognosis in Critically Ill Patients: https://bit.ly/3jiKT1L Renin and Survival in Patients Given Angiotensin II for Catecholamine-Resistant Vasodilatory Shock: https://bit.ly/2G1tZGB Additional Content Related to Angiotensin II: Angiotensin II for Vasodilatory Shock: 2019 Update: https://bit.ly/3hvVkyA Personalization of Vasopressor Therapy in the Treatment of Vasodilatory Shock: https://bit.ly/3hy7wyD

THIS IS NOT A PHARMACOLOGICAL DISCUSSION, THIS IS A STRATEGIC ONE.  Some thoughts on how , when and why we use them.   Please Like, Comment and Subscribe!  #vasopressors # ionotropes #icu #criticalcare # shocks 

In this podcast, Editor-in-Chief Jeanette Hasse, PhD, RD, FADA, CNSC, interviews Rosemary Kozar, MD, co-author of the article, "Feeding the Post-operative Patient on Vasopressor Support," published in the February 2016 issue of NCP. https://doi.org/10.1177/0884533615619932

Dr. Michael Lanspa sits down with Dr. Hayley Gershengorn to discuss the article “Association of Pre-Morbid Blood Pressure with Vasopressor Infusion Duration in Patients with Shock”.

Acute Liver FailureSpecial Guest: Stephanie Bass, PharmD, BCPS, BCCCP Show Notes: https://pharmacytodose.files.wordpress.com/2020/05/acute-liver-failure-show-notes.pdf Reference List: https://pharmacytodose.files.wordpress.com/2020/05/acute-liver-failure-references.pdf 03:05 – Stephanie’s interest in the liver; 05:54 – Diagnosing ALF; 07:20 – Does having liver disease increase ALF risk?; 09:00 – Ultimate goal when treating ALF; 10:07 – Patient presentation; 11:58 – Common causes of ALF; 13:30 – ICP and cerebral edema management in ALF; 15:50 – PAD management in ALF; 18:55 – Acute hepatic encephalopathy management; 21:00 – Trending ammonia levels?; 22:25 – NAC for APAP overdose ALF; 27:11 – NAC for non-APAP overdose ALF; 30:23 – Albumin for ALF fluid resuscitation; 34:33 – Vasopressor use; 36:53 – Blood pressure goals; 40:00 – TEG for bleeding risk assessment; 43:45 – Hemostatic agents for coagulopathy; 46:18 – Anticoagulant of choice; 47:59 – Hepatic dose adjustments; 52:12 – Medication dosing with MARS/RRT; 54:00 – Medications to avoid; 56:02 – Transplant considerations; 58:24 – Take-home points PharmacyToDose.Com@PharmacyToDose on Twitter/InstagramPharmacyToDose@Gmail.com

What are the indications for ECMO beyond ARDS and refractory cardiogenic shock? In which patients should we consider eCPR and is this the new standard of care for patients sustaining out-of-hospital cardiac arrest? Finally, how do I work towards safely and efficiently weaning my patient from VV or VA ECMO? These are just a few of the questions that we address on Rounds with our guest faculty member and Director of the UCLA Adult ECMO Program, Dr. Peyman Benharash. In this comprehensive review of ECMO we also explore the regionalization of ECMO care here in Los Angeles County, as well as the day-to-day considerations that you want to bear in mind when assessing and caring for your patients requiring extracorporeal life support.Learning ObjectivesBy the end of rounds you should be able to:1. Understand the indications & contraindications to VV and VA ECMO support2. Describe the basic components of an ECMO circuit3. Describe the role of eCPR in the management of adult patients with out-of-hospital cardiac arrest4. Discuss key management strategies to safely wean patients from ECMO5. Describe common complications of ECMO and strategies to mitigate themTake Home PointsECMO is time-sensitive, therefore, early and safe cannulation is an important determinant of outcomeECMO is a bridge to therapyUse of scoring systems like the Murray Score may be useful to stratify the severity of ARDS among patients being considered for VV ECMO supportThe indications for ECMO are expanding to include technically challenging operative caseseCPR is a promising therapy for patients presenting to an ECMO center of excellence with refractory VF/VT cardiac arrest ECMO therapy, particularly VA ECMO, may affect virtually organ systemThe potential role of ECMO therapy during the current COVID-19 pandemic remains to be definedTime Stamps00:12 Introduction01:16 Overview of Rounds 02:13 The rise of ECMO 02:46 CESAR & EOLIA trials summarized 05:40 Venovenous (VV) vs. Venoarterial (VA) ECMO08:24 How to decide whether or not to place a patient on VA ECMO? 10:33 Timing & indications for ECMO support11:38 Murray Score explained12:24 Contraindications & patient selection for VV & VA ECMO13:56 Expanding indications for ECMO15:23 ECMO in the Setting of Trauma: Pneumonectomy & Retrohepatic IVC injuries17:45 Regionalization of ECMO in Los Angeles County21:52 Who should be cannulating?23:22 Approach to cannulation24:50 Distal perfusion catheters for VA ECMO26:10 Differences between VV & VA ECMO28:24 The W5H of eCPR34:26 Considerations for access for VV ECMO35:53 Avalon catheter 37:51 VV versus VA ECMO circuits/set-up explained43:30 Getting your patient off of ECMO & other key considerations48:56 Vasopressor & inotropic therapy during VA ECMO50:31 Virchow’s triad, antithrombotic therapy & bleeding on ECMO54:30 AKI, end-organ dysfunction & the daily assessment of patients on ECMO57:22 ECMO 2.0 & the role of evolving technologies61:20 Role of ECMO during the COVID-19 pandemic 66:45 Take-home points68:38 Outro

Vasopressor use in the Pediatric Emergency Department has been a moving target for my entire career. Back when I was a resident and fellow we used Dopamine. Then we went to epinephrine because it can be given through a peripheral IV because norepinephrine was too dangerous to run peripherally. But maybe that’s not entirely true. […]

Critical Care Management of COVID-19Special Guests: Drayton Hammond, PharmD, MBA, MSc, BCPS, BCCCP, FCCMPeter Nikolos, PharmD Show Notes: https://pharmacytodose.files.wordpress.com/2020/04/covid-19-complications-show-notes.pdf Mechanical Ventilation (Drayton)08:00 – Non-COVID-19 PAD management; 11:16 – COVID-19 PAD management; 18:22 – Managing PAD drug shortages; 22:38 – Opioid conservation strategies; 26:08 – Propofol conservation strategies; 29:08 – Hypertriglyceridemia with propofol; 32:10 – Risk of PRIS; 34:30 – Ketamine; 41:05 – NMBA use and shortage; 46:00 – PPE conservation; 49:00 – Bronchodilator use for COVID-19; 50:28 – Inhaled anticoagulants; 52:46 – Inhaled pulmonary vasodilators; 54:17 – Advice for COVID-19 management Cardiovascular (Peter)67:20 – Current shortages; 71:05 – First-line vasopressor; 73:25 – Vasopressor compounding and utilization changes; 74:50 – Smart pump management; 77:15 – Vasopressor shortage management; 79:45 – Anticoagulation treatment strategy; 85:30 – Anticoagulation monitoring; 86:28 – Anticoagulation in ECMO/CRRT; 88:20 – PE causing rapid decompensation?; 90:25 – Alternate anticoagulants; 92:52 – Thrombolytics in ACS; 98:13 – Code response changes; 100:05 – ACE-I/ARB use in COVID-19; 103:41 – NSAID use in COVID-19; 105:15 – Statin use in COVID-19; 107:25 – Challenges from virtual rounding; 110:20 – Key points on COVID-19 management PharmacyToDose.Com@PharmacyToDose on Twitter/InstagramPharmacyToDose@Gmail.com

Basics of  Hemodynamics Shock  Sepsis Why Swans can be a problem.  Vasopressor review.   #FOAMED #MEDED #COVID-19 #Hemodynamics #ICU #criticalcare #ER #resuscitation

Show notes at pharmacyjoe.com/episode490. In this episode, I’ll discuss the discontinuation order of vasopressors. The post 490: Which vasopressor should be discontinued first? appeared first on Pharmacy Joe.

Vasopressor administration to maintain higher map in patients >65 years of age has become a dogma. In this podcast, we discuss recently published 65 trial which not only challenges this dogma but will definitely change our practices. 

Show notes at pharmacyjoe.com/episode474. In this episode, I ll discuss a long-awaited randomized, controlled trial of vitamin C, thiamine, an hydrocortisone in sepsis. The post 474: Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock appeared first on Pharmacy Joe.

It it the end of Sepsis Awareness Month, but there is a BONUS Monday (Sept. 30th), so why not a BONUS episode! Join the EMGuideWire Team as they explore the challenges the children bring to this clinical condition. Let's review Pediatric Sepsis! Pearls: Screening should be age adjusted. Identify severe sepsis. Treat w/early antibiotics, balanced fluid administration, and EPI if needed.   SIRS in children must be age-adjusted. HR & RR > 2 standard deviations of nml; WBC age adjusted.  Screen: high risk medical history + vital sign abnormalities (age based SIRS) require check of cap refill, mental status, and general appearance followed by a physician assessment. Identify: Severe sepsis = sepsis + organ dysfunction (CV/resp/neuro/renal/hepatic dysfunction). Order a lactate, CBC, CMP, and blood cultures, and consider CXR and UA. CRP is helpful for inpatient team.  Higher lactate has higher mortality and is associated with septic shock. Treat: Start 20cc/kg bolus LR and reassess. Those with heart disease can’t take anymore fluids after this, so only add pressors if needed. Continue to 40cc/kg and up to 60cc/kg total bolus prior to pressors for other patients.  If still hypotensive, start 0.1 mcg/kg/min of EPI (peripheral or IO).  Early antibiotics saves lives.  LR is better than NS.   Summarized by: Travis Barlock, MD PGY-1 References: Emrath ET, Fortenberry JD, Travers C, McCracken CE, Hebbar KB. Resuscitation With Balanced Fluids Is Associated With Improved Survival in Pediatric Severe Sepsis. Critical Care Medicine. 2017 Jul;45(7):1177-1183 Ventura et al. Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock. Critical Care Medicine. 2015; 43(11):2292-302  

Join the EMGuideWire Crew as they continue to explore the High Yield management points for Sepsis!  This week's Episode's Pearls: Early fluids save lives. Give 40cc/kg bolus in first 3 hours. But don’t fluid overload the patient! U/S the heart and lungs: A plethoric IVC, immobile mitral valve, and B lines on the lungs should urge you to be more cautious with fluids. Goal in all patients is to establish an adequate MAP ASAP! Fluids + Vasopressors! Vasopressor titration algorithm: First low dose NE (10mcg/min); if still in shock, initiate vasopressin (0.04 units/min); do not wait on providing vasopressin if EPI is readily available (establish MAP ASAP!).  Initiate vasopressors early with fluids! NE can be initiated peripherally, so don’t wait for a central line! Only consider dopamine for absolute bradycardia.  Methylene blue is a last resort consideration.  Vasopressors are commonly needed at high doses (i.e., 1mcg/kg/min EPI).  Hydrocortisone 50-100mg for patients with septic SHOCK, not sepsis alone.  Summarized by: Travis Barlock, MD PGY-1 References: Farkas J. PulmCrit- Epinephrine challenge in sepsis: An empiric approach to catecholamines. EMCrit Project. https://emcrit.org/pulmcrit/epi/. Published August 21, 2018. Accessed September 17, 2019. Dellinger RP, Levy MM, Rhodes A, et al. 2017. Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup: Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2016. Critical Care Medicine. 44(3):486-552.

In this episode of Critical Matters, listen to the recording of Sound Critical Care’s webinar, Personalized Selection of Vasopressors in the Treatment of Shock. Our guest for this episode is Dr. Lakhmir Chawla, Chief Medical Officer of La Jolla Pharmaceutical in San Diego, California. During this webinar, we discuss lessons learned from the clinical use of the new vasopressor Angiotensin II, as well as personalization of vasopressor therapy in the treatment of vasodilatory shock. Watch the video recording: https://bit.ly/2jZ1z5h

In our first episode, we discuss the potential role of Angiotensin II for treating shock and review the results of the ATHOS-3 clinical trial. Our guest is Stephen W. Trzeciak, MD, MPH. Dr. Trzeciak is Interim Chair of Internal Medicine and Head of Critical Care Medicine at Cooper University Health Care. Dr. Trzeciak holds academic appointments as Professor of Medicine and Professor of Emergency Medicine at Cooper Medical School of Rowan University. He is also a prolific investigator and author, with recognized expertise in the treatment of shock, early interventions in critical illness, and the interface between the emergency department and the intensive care unit. Additional Resources: - Sound Critical Care webinar on vasopressors. Please review for a more comprehensive discussion on current evidence-based vasopressor use in clinical practice. - ATHOS-3 clinical trial. Randomized controlled trial evaluating the efficacy of Angiotensin II in raising blood pressure in vasodilatory shock. - FDA press release. After recording this podcast, the FDA announced the approval of Angiotensin II.

Kontakt: ivajuntan@gmail.com    Musik: Blind Love Dub by Jeris (c) copyright 2017 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/VJ_Memes/55416 Ft: Kara Square (mindmapthat)    Om du gillar du det vi gör - stöd Life Support Foundation! www.lifesupportfoundation.org     Bli månadsgivare eller används Swish: 1234610804    - Dagens artiklar:   https://www.ncbi.nlm.nih.gov/pubmed/29860705   https://www.ncbi.nlm.nih.gov/pubmed/29854752   https://www.ncbi.nlm.nih.gov/pubmed/30303836  

Goals on Initiation Reverse shock and increase tissue perfusion: Improve blood flow BP (MAP >65) perfuse coronaries and brain Mental status End tidal CO2 Maybe:  urine output (if Foley present) & capillary refill time Increase venous return Avoid ischemia & other adverse events Which vasopressor do I choose? It depends. For the prehospital provider, most of these are not an option. However, having one pressor that you're familiar with that can be implemented safely and rapidly is probably more beneficial to the patient than not using a pressor at all, or worse, using it incorrectly. Currently, norepinephrine is recommended as first line in the vast majority of shock states. However,  this is only commercially available in a vial as a concentrated solution, requiring drip preparation. Most EMS Providers in our area are either more familiar with dopamine or have it as their only option per Protocol.  This is likely due to it being a commercially available pre-mixed drip.  In short term, may be fine, but is more arrhythmogenic than norepinephrine. Alternatively, "Dirty" Epi is an option: 1 mg into a 1,000 mL NS (conc 1 mcg/mL). Maximum rate of infusion will vary with catheter size, IV bag height, and squeeze on the bag; however, with a wide-open 18-gauge IV, the patient will receive about 20-30 mL/min (or 20-30 mcg/min) of epinephrine, which is similar to the recommended push-dose epi (0.1 mg or 100 mcg over 5 minutes = 20 mcg per min Run wide open in your peripheral IV or IO until the patient’s hemodynamics stabilize. Can set up the pump, follow  protocols, and perform double-checks. Adequate labeling is important to mitigate errors. Or, compel your service administrators to buy the right equipment (IV Pumps) and the right vasopressor (Norepi). Vasopressors Turn Unstressed Volume Into Stressed Volume Unstressed Volume - Vol­ume of fluid to fill the vascular bed to the point where its presence exerts force on the vessel walls Stresssed Volume - Anything greater ⇒ which will exert an increasing degree of pressure on the venous vascular bed ⇒ determines flow Vasopressor Classification - A Simpler Approach Pure vasopresors (isolated vessel squeeze) Phenylephrine Vasopressin Vasopressor with ionotrophy (both vessel & heart squeeze) Norepinephrine Epinephrine Dopamine Ionotropes with vasodilators (heart squeeze & vasodilation) Dobutamine Milrinone Maximum doses vary greatly between institutions.  It is likely that your hospital or agency has set a maximum dose for each vasopressor.  Maximum doses can be exceeded if needed to maintain hemodynamics. When to Titrate (frequency) Peripheral Administration Tips for peripheral administration: Use well functioning 18-20G IV proximal to the wrist Place BP cuff on opposite arm Regularly inspect IV site for signs of extravasation Ask patient to report discomfort around IV site Be prepared to manage extravasation Prolonged administration = Central access Extravasation Management Compatibility Sterility When properly mixing Push Dose Epinephrine, repeated entries into any one container should be limited to maintain integrity/sterility of the original container. Ways to limit puncturing the carpuject, as described by Dr. Baum in the podcast: Instead of puncturing the carpuject, it may be more more sterile to remove needleless cap from the Epi and insert it into the tip of the 10 cc syringe. Or... Purchase a Luer Lock-to-Luer Lock  connector so you don't have to expose a needle. Care Transitions Be cautious when stopping drips when delivering patient to the hospital.  This is especially important with agents like vasopressors as they have short half-lives.  Patients needing these for support may decline.  Best practice is to transition to hospital product before discontinuing. Reporting of infusion rates during hand off:  Medication infusions need to be reported in a concentration per time Examples: mg/hr or mcg/kg/min or units/hr ml/hr is NEVER appropriate due to differing concentrations of medication infusions Vasopressors may be dosed in mcg/min or mcg/kg/min beware of units IV fluids like normal saline and lactate ringers ml/hr is appropriate. Special thanks to Dr. Regan Baum for providing us with these notes and images. A few additions were made by Curbside to Bedside.

Kontakt: ivajuntan@gmail.com Musik: Blind Love Dub by Jeris (c) copyright 2017 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/VJ_Memes/55416 Ft: Kara Square (mindmapthat) Dagens huvudartikel: https://journal.chestnet.org/article/S0012-3692(18)30072-2/fulltext Och några sköna artiklar om vasopressin... https://insights.ovid.com/crossref?an=00003246-900000000-96123 https://insights.ovid.com/crossref?an=00003246-900000000-96123 https://jamanetwork.com/journals/jama/fullarticle/2680546 https://academic.oup.com/ejcts/article/29/6/952/425297 Och så den där reviewen om högerkammarsvikt som jag lovade... https://academic.oup.com/ejcts/article/29/6/952/425297  

Exsanguination and brain injury are the leading causes of death after major trauma. During the last decades, significant progress has been made in the fight against haemorrhage. Nevertheless, the window of opportunity is still small, and the golden hour of shock more fiction than fact. Hence, the majority of trauma patients is still lost on the street and during the first hour after hospital admission. Moreover, trauma is an increasing epidemiologic burden worldwide. Pre-hospital emergency care plays an essential role when distances are long and immediate damage control is key. Since evidence of established interventions (i.e. fluid resuscitation or vasopressor use) is spare, we summarized currently available trauma care guidelines, and elaborated a best practice advice for massive bleeding comprising a five-step approach: First identification, on-going monitoring and appropriate notification of the receiving hospital. Second, control of haemorrhage by tourniquets and pelvic splints; and advanced interventions, such as emergency resuscitative thoracotomy and resuscitative endovascular balloon occlusion. Third, target controlled fluid resuscitation within the concept of hypotensive resuscitation in order to prevent hypovolemic cardiac arrest during the pre-hospital phase. Fourth, pharmacologic interventions employing vasopressor drugs and medication for coagulation management. Fifth, avoiding mistakes in anesthetized and ventilated patients with critical intravascular volume status, as well as means to counteract inadvertent hypothermia. Finally, a minimum data set allowing retrospective analysis and system comparison is needed. In conclusion, code red protocols are key in order to reduce pre-hospital care to the max and to pave the way to major trauma care. Current concepts of trauma care with a strong focus on the C-ABC (Circulation-Airway-Breathing-Circulation) approach, hypotensive resuscitation, haemostatic resuscitation and damage control surgery improve survival after major trauma.

Commentary by Dr. Valentin Fuster

Show notes at pharmacyjoe.com/episode306. In this episode I ll: 1. Discuss an article on the discontinuation order of vasopressors in the management of septic shock. 2. Answer the drug information question Why is daptomycin dosed once daily?” 3. Share a tip for responding to inpatient medical emergencies. The post 306: Order of vasopressor discontinuation, why is daptomycin dosed once daily, and a tip for responding to inpatient medical emergencies appeared first on Pharmacy Joe.

Why is “prime the pump”, dying?   It’s now accepted that sepsis has more to do with vasodilation, and less to do with vascular permeability. Administering a vasopressor turns unstressed volume into stressed volume and improves venous return.   Not every patient will respond to fluid administration with an increase in cardiac output.   How much fluid do we give in septic shock, and when do we start a vasopressor?   “Just the right amount”, and as soon as it’s evident the patient isn’t or WON’T respond to fluid administration.   An interesting, possible way for Prehospital Providers to determine fluid responsiveness:   You can test for fluid responsiveness without giving a drop of fluid by using ETCO2 and Passive Leg Raise, but it might not be ready for prime time.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129784/   What should be the first line vasopressor for vasodilatory shock?   Norepinephrine if you have it, but Epinephrine is fine, and may be preferred in select cases.

Sean P. Kane, PharmD, BCPS, speaks with Scott T. Benken, PharmD, BCPS-AQ Cardiology about vasopressor selection in septic shock. In the episode, each vasopressor agent is discussed individually regarding its receptor profile, adverse effect profile, and the comparative clinical evidence supporting its use in this patient population.

Sean P. Kane, PharmD, BCPS, speaks with Scott T. Benken, PharmD, BCPS-AQ Cardiology about vasopressor selection in septic shock. In the episode, each vasopressor agent is discussed individually regarding its receptor profile, adverse effect profile, and the comparative clinical evidence supporting its use in this patient population.

Generic Name epinephrine Trade Name Adrenalin, EpiPen Indication asthma and COPD exacerbations, allergic reactions, cardiac arrest, anesthesia adjunct Action Affects both beta1 and beta2 also has alpha agonist properties resulting in bronchodilation and  increases in HR and BP. Inhibits hypersensitivity… The post Epinephrine (Adrenalin, EpiPen): antiasthmatic, bronchodilator, vasopressor appeared first on NURSING.com.

There is a ton to speak about regarding vasopressors, but before we get to the edge cases, we need to set-up a foundation.

Can we give vasopressors peripherally? And if we do, what if they leak?

In der Pferdeanästhesie stellen Herzkreislaufdepressionen bis hin zum Herzstillstand und postanästhetische Myopathien trotz bestmöglicher Optimierung der Narkosemethoden und der eingesetzten Stoffe bzw. Stoffkombinationen nach wie vor ein großes Problem dar. Für die Behandlung hypotensiver Zustände während einer Allgemeinanästhesie werden in der Literatur verschiedene Stoffe empfohlen, wobei in Deutschland bei Pferden vor allem Dopamin, Dobutamin und Etilefrin verwendet werden. In dieser Studie sollten diese Medikamente auf die Dauer bis zu ihrem Wirkungseintritt, auf die Wirkungsintensität und Wirkungsdauer hin untersucht und miteinander verglichen werden. Anhand von Laktatwertmessungen jeweils vor der Narkoseeinleitung und zum Narkoseende sollte zusätzlich festgestellt werden, ob ein bedeutsamer Anstieg des Laktatwerts während der Narkose als Hinweis auf negative Auswirkungen der Anästhesie oder der Lagerung der Pferde nachweisbar ist. Es wurden 146 Patienten der Klinik für Pferde der Ludwig-Maximilians-Universität München während der Narkose und der Aufstehphase überwacht Die dabei dokumentierten Parameter waren neben Signalement, Anamnese und Art der Operation, die Art und Dosierung der Sedation sowie der Herzfrequenz- und Blutdruckverlauf. Bei 82 dieser Patienten wurde zusätzlich der Laktatwert im Blut vor dem Niederlegen und zu Narkoseende, vor der Aufstehphase gemessen. Bei den Pferden, bei denen der Blutdruck während der Narkose unter 70 mmHg sank, wurde entweder Dopamin, Dobutamin oder Etilefrin als Infusion nach Wirkung verabreicht. Etilefrin wurde zusätzlich als Bolus injiziert. Insgesamt 31 Patienten wurden einmal oder mehrmals mit einem Vasopressor behandelt. Zusätzlich erhielten 10 Pferde unmittelbar nach der Narkoseeinleitung als Hypotensions-Prophylaxe eine Dobutamin-Infusion in der halben therapeutischen Dosierung. Die Laktatbestimmungen ließen einen höchst signifikanten Anstieg des Laktatwerts während der Narkose erkennen. Allerdings konnte keine Korrelation mit der Art der Lagerung (seitlich oder dorsal), dem Gewicht und dem Alter der Pferde und dem mittleren Blutdruck nachgewiesen werden. Der Vergleich der Vasopressoren zeigte, dass bei rapide abfallendem Blutdruck während einer Narkose die Verabreichung von Etilefrin Vorteile gegenüber der Gabe von Dopamin und Dobutamin hat, da es am schnellsten und effektivsten Blutdruck steigernd wirkte. Der Blutdruck war mit den Dobutamin- und Etilefrin-Infusionen besser steuerbar, als mit der die Etilefrin-Bolusinjektion. Die Etilefrin-Infusion hat eine etwas stärkere und zuverlässigere Wirkung gezeigt, als die Dobutamin-Infusion. Der Nachteil von Etilefrin war ein vermehrtes Schwitzen, das sich sowohl nach Bolusinjektion als auch nach Tropfinfusion eingestellt hat. Ein Nachteil von Dobutamin ist eine herzschlagsynchrone Erschütterung des Körpers in der der Kopf-, Hals- und Schulterregion, der bei Operationen in diesem Bereich erheblich stören kann. Dopamin wurde bei 7 Probenden eingesetzt und erbrachte hier keine befriedigenden Ergebnisse. Es war nach Dopamin-Gabe keine Anhebung des Blutdrucks nachvollziehbar und es trat wie bei Dobutamin eine Erschütterung des Körpers in der der Hals- und Schulterregion auf.