Fluid Therapy ; Hemodynamics ; Humans ; Resuscitation ; Shock ; therapy ; Shock, Hemorrhagic ; Shock, Septic

Cardiogenic shock (CS) is a complex condition causing end-organ hypoperfusion and high mortality rates especially in patients with acute myocardial infarction. It remains a challenge for clinician to provide good outcomes despite the development of evidence-based therapeutic strategies, especially for interventional management. Although there has been an improvement in survival, the mortality remains high. There are still many uncertainties regarding the best treatment, as clinicians need to weigh the risks and benefits. This review aims to elaborate the latest updates in the field of CS. To enhance contractility and systemic vascular resistance and hence avoid organ damage, inotropic and vasopressin agents are often administered in the therapy of CS. Despite their usefulness and widespread use, administration of these medicines requires close monitoring and the lowest effective dosage administered in the shortest amount of time possible to prevent adverse effects including increased oxygen demand, arrhythmia, and impaired microcirculation of the tissue. When pharmacological agents fail to provide an adequate response, mechanical circulatory support (MCS) devices like the intraaortic balloon pump (IABP), left ventricular assist devices (LVAD), venoarterial extracorporeal membrane oxygenation (VA-ECMO), and revascularization become an option to provide haemodynamic support.
Shock, Cardiogenic

Diagnosis and treatment criteria were recently updated based on the Sepsis-3 guidelines, which recommend the sequential organ failure assessment for accurate characterization of organ dysfunction. Large randomized controlled trials have found neutral results with early goal-directed therapy. To improve outcomes, treatment bundles incorporating standards for early sepsis treatment, including antibiotic and steroid treatment, were developed. Thus, future research should address the effects of steroids and immune-modulating agents on refractory septic shock as well as the development of new coagulopathy therapies and dynamic assessment tools.
Diagnosis ; Sepsis ; Shock, Septic ; Steroids ; Systemic Inflammatory Response Syndrome

Introduction: Septic shock is the most common type of shock encountered by internists and is the most common cause of death in non-coronary intensive care units. In the 2012 Surviving Sepsis Campaign, one recommendation is antibiotic administration within three hours from sepsis recognition. Several large-scale studies challenged this recommendation with contrasting results. The researchers aim to determine the impact of early antibiotic therapy (EAT) on mortality and outcome of patients and to determine institutional compliance to current sepsis recommendations. Methods: This retrospective single center study included septic patients at the emergency room from February 2013 to January 2015 and were grouped into the EAT group (lesser than or equal to three hours) and control group (more than three hours) antibiotic initiation from sepsis recognition). Primary outcomes are in-hospital mortality, time-to-antibiotics and extraction of blood culture prior to antibiotics. Secondary outcomes include length of hospital stay, use of vasopressors and mechanical ventilation and development of sepsis-related complications. Results: Two-hundred sixty-one patients were included with 53.26% overall mortality rate. The overall mean timeto-antibiotics is 355.1 minutes and time-to-blood culture is 434.64 minutes. Mean time-to-antibiotics were 115 and 556 minutes in the EAT and control group respectively. Mortality was significantly higher in the control group (43.7% vs. 61.3%, p=0.006). For the sepsis related complications, development of acute kidney injury (p=0.033) was higher in the EAT group and acute respiratory failure (p=0.009) was significantly increased in the control group. Conclusion Antibiotic administration within three hours from sepsis recognition significantly reduced in-hospital mortality. Timing of antibiotics and collection of blood cultures were delayed compared to current recommendations. Among the sepsis-related complications, prolonged time-to-antibiotics (>3 hours) is associated with risk of developing acute respiratory failure and subsequent need for mechanical ventilation.
Early antibiotic therapy ; Shock, Septic ; Sepsis ; Systemic Inflammatory Response Syndrome

Despite the development of modern intensive care and new antimicrobial agents, the mortality of the patients with severe sepsis and septic shock remains high. The poor outcome is considered to be a consequence of an overactive systemic inflammatory response. Sepsis is now defined as systemic inflammatory response syndrome (SIRS) in which there is an identifiable focus of infection. As a consequence of the overactive SIRS response, the function of various organ systems may be compromised, resulting in multiple organ dysfunction syndrome (MODS) and death. Systemic inflammation is a consequence of activation of the innate immune system. It is characterized by intravascular release of pro-inflammatory cytokines and other vasoactive mediators, and the concurrent activation of the innate immune cells. In addition to the pro-inflammatory reactions, the host's anti-inflammatory mechanisms are also activated and aimed at counteracting the inflammatory response. The balance between pro- and anti-inflammatory reactions is critical for the outcome of the patient. Understanding the mechanisms of acute inflammatory responses in critical ill patients is necessary for the development of urgently needed therapeutics. The aim of this review is to provide a description of the key components and mechanisms involved in the inflammatory response in patients with SIRS and sepsis.
Anti-Infective Agents ; Cytokines ; Humans ; Immune System ; Inflammation ; Critical Care ; Multiple Organ Failure ; Sepsis ; Shock, Septic ; Systemic Inflammatory Response Syndrome

No abstract available.
Resuscitation* ; Shock, Hemorrhagic*

No abstract available.
Nitric Oxide* ; Shock, Hemorrhagic*

No abstract available.
Infusions, Intraosseous* ; Resuscitation* ; Shock, Hemorrhagic*

No abstract available.
Heart Rate* ; Heart* ; Shock, Hemorrhagic*

BACKGROUND: Early goal-directed therapy (EGDT) has been used for patients with severe sepsis and septic shock in the emergency department (ED). In 2003, international management guidelines for severe sepsis and septic shock were developed under the auspices of the Surviving Sepsis Campaign (SSC); however, EGDT based on the SSC was not fully evaluated in the ED. The purpose of this study was to evaluate the efficacy of EGDT based on the SSC in the ED in Korea. METHODS: We randomly assigned patients who arrived at our ED in septic shock to receive EGDT before admission to the intensive care unit between May 2007 and July 2007, and we retrospectively assigned patients in septic shock to receive standard therapy between May 2006 and July 2006. The in-hospital mortality for 24 hours and 28 days, the MODS, SAPS II, and APACHE II scores were obtained and compared between the study groups. RESULTS: Of the 60 enrolled patients, 30 were assigned to EGDT and 30 were assigned to standard therapy. There was no significant difference between the groups with respect to the baseline characteristics. In-hospital mortality at 28 days was 13% in the group assigned to EGDT as compared to 40% in the group assigned to standard therapy (p = 0.020) and in-hospital mortality at 24 hours was 0% and 13%, respectively (p = 0.038). CONCLUSIONS: EGDT provides significant benefits with respect to outcome in patients in septic shock.
APACHE ; Emergencies ; Hospital Mortality ; Humans ; Intensive Care Units ; Korea ; Multiple Organ Failure ; Retrospective Studies ; Sepsis ; Shock, Septic ; Systemic Inflammatory Response Syndrome