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Shock cardiogénico: Falla de la entrega y uso del oxígeno
Cardiogenic Shock: Failure of Oxygen Delivery and Oxygen Utilization.
Clin Cardiol. 2016 Aug;39(8):477-83. doi: 10.1002/clc.22564. Epub 2016 Aug 10.
Abstract
Cardiogenic shock remains a highly lethal condition. Conventional therapy including revascularization and mechanical circulatory support aims to improve cardiac output and oxygen delivery, but increasing basic and clinical observations indicate wider circulatory and cellular abnormalities, particularly at the advanced stages of shock. Progressive cardiogenic shock is associated with microcirculatory and cellular abnormalities. Cardiogenic shock is initially characterized by a failure to maintain global oxygen delivery; however, progressive cardiogenic shock is associated with the release of pro-inflammatory cytokines, derangement of the regulation of regional blood flow, microcirculatory abnormalities, and cellular dysoxia. These abnormalities are analogous to septic shock and may not be reversed by increase in oxygen delivery, even to supranormal levels. Earlier mechanical circulatory support in cardiogenic shock may limit the development of microcirculatory and cellular abnormalities.
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Adrenomedulina. Un marcador de daño hemodinámico, disfunción orgánica y mal pronóstico en shock cardiogénico
Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock.
Tolppanen H1,2,3, Rivas-Lasarte M4,5, Lassus J6, Sans-Roselló J5, Hartmann O7, Lindholm M8, Arrigo M4,9,10, Tarvasmäki T11, Köber L8, Thiele H12, Pulkki K13,14, Spinar J15,16, Parissis J17, Banaszewski M18, Silva-Cardoso J19, Carubelli V20, Sionis A5, Harjola VP11, Mebazaa A4,21,22.
Abstract
BACKGROUND: The clinical CardShock risk score, including baseline lactate levels, was recently shown to facilitate risk stratification in patients with cardiogenic shock (CS). As based on baseline parameters, however, it may not reflect the change in mortality risk in response to initial therapies. Adrenomedullin is a prognostic biomarker in several cardiovascular diseases and was recently shown to associate with hemodynamic instability in patients with septic shock. The aim of our study was to evaluate the prognostic value and association with hemodynamic parameters of bioactive adrenomedullin (bio-ADM) in patients with CS. METHODS: CardShock was a prospective, observational, European multinational cohort study of CS. In this sub-analysis, serial plasma bio-ADM and arterial blood lactate measurements were collected from 178 patients during the first 10 days after detection of CS. RESULTS: Both bio-ADM and lactate were higher in 90-day non-survivors compared to survivors at all time points (P < 0.05 for all). Lactate showed good prognostic value during the initial 24 h (AUC 0.78 at admission and 0.76 at 24 h). Subsequently, lactate returned normal (≤2 mmol/L) in most patients regardless of later outcome with lower prognostic value. By contrast, bio-ADM showed increasing prognostic value from 48 h and beyond (AUC 0.71 at 48 h and 0.80 at 5-10 days). Serial measurements of either bio-ADM or lactate were independent of and provided added value to CardShock risk score (P < 0.001 for both). Ninety-day mortality was more than double higher in patients with high levels of bio-ADM (>55.7 pg/mL) at 48 h compared to those with low bio-ADM levels (49.1 vs. 22.6%, P = 0.001). High levels of bio-ADM were associated with impaired cardiac index, mean arterial pressure, central venous pressure, and systolic pulmonary artery pressure during the study period. Furthermore, high levels of bio-ADM at 48 to 96 h were related to persistently impaired cardiac and end-organ function. CONCLUSIONS: Bio-ADM is a valuable prognosticator and marker of impaired hemodynamics in CS patients. High levels of bio-ADM may show shock refractoriness and developing end-organ dysfunction and thus help to guide therapeutic approach in patients with CS. Study identifier of CardShock study NCT01374867 at clinicaltrials.gov.
KEYWORDS: Adrenomedullin; Biomarkers; Cardiogenic shock; Hemodynamics; Lactate; Mortalit
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Conceptos actuales en choque cardiogénico
Dr. Octavio González-Chon, Dr. Javier Sánchez-Zavala, Dr. Eduardo Arias-Sánchez, Dra.Sandra María del Carmen García-López
Revista Mexicana de Anestesisoslogía Vol. 32. Supl. 1, Abril-Junio 2009 pp S65-S67
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Curso Internacional de Actualidades en Anestesiología
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Cuidad de México, Febrero 9-11, 2017
Informes ceddem_innsz@yahoo.com
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Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
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California Society of Anesthesiologists
Annual Meeting April 27-30, 2017
San Francisco California
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