Patterns of Microvascular Response to Refractory Shock and Their Modulation by Vasoactive Resuscitations

AbstractAlthough extracorporeal membrane oxygenation (ECMO) is increasingly utilized, only a limited level of experience has been reported in postpartum cardiopulmonary failure. Ten critically ill postpartum patients who received ECMO were included between January 2010 and December 2018 in this retrospective observational study. The main indication for ECMO support was peripartum cardiomyopathy (n = 5), followed by postpartum hemorrhage (n = 2). Nine patients initially received veno-arterial ECMO, and one patient received veno-venous ECMO. Major bleeding occurred in six patients. The median number of units of red blood cells (RBC) transfused during ECMO was 14.5 units (interquartile range 6.8–37.8 units), and most RBC transfusions occurred on the first day of ECMO. The survival-to-discharge rate was 80%. Compared to the survival outcomes in female patients of similar age who received ECMO, the survival outcomes were significantly better in the study population (56% versus 80%, P = 0.0004). Despite the high risk of major bleeding, ECMO for patients with postpartum cardiac or respiratory failure showed excellent survival outcomes. ECMO is feasible in these patients and can be carried out with good outcomes in an experienced centre.

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The Role of Invasive Hemodynamic Monitoring in an Unusual Case of Refractory Shock

Annals of the American Thoracic Society ◽

10.1513/annalsats.201406-290cc ◽

2014 ◽

Vol 11 (9) ◽

pp. 1497-1499

Author(s):

Christopher DeCotiis ◽

Mauricio Danckers ◽

Robert O. Roswell ◽

Kenneth I. Berger

Keyword(s):

Hemodynamic Monitoring ◽

Unusual Case ◽

Refractory Shock ◽

Invasive Hemodynamic Monitoring

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Abnormal microvascular response is localized to the digits in patients with systemic sclerosis

Arthritis & Rheumatism ◽

10.1002/art.21911 ◽

2006 ◽

Vol 54 (6) ◽

pp. 1952-1960 ◽

Cited By ~ 28

Author(s):

A. K. Murray ◽

T. L. Moore ◽

T. A. King ◽

A. L. Herrick

Keyword(s):

Systemic Sclerosis ◽

Microvascular Response

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Microvascular Response to Hemorrhage in the Rat during Nitrous Oxide (N2O ) Relaxant Anesthesia

Microcirculation ◽

10.1007/978-1-4613-4337-0_36 ◽

1976 ◽

pp. 173-174

Author(s):

David E. Longnecker ◽

Nan M. Rogier

Keyword(s):

Nitrous Oxide ◽

Microvascular Response

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Unresponsive shock due to amlodipine overdose: An unexpected cause

Journal of Cardiovascular and Thoracic Research ◽

10.15171/jcvtr.2018.43 ◽

2018 ◽

Vol 10 (4) ◽

pp. 246-247 ◽

Cited By ~ 2

Author(s):

Shailesh Kumar ◽

Devyani Thakur ◽

Ritesh Kumar Gupta ◽

Alka Sharma

Keyword(s):

Channel Blocker ◽

Kidney Injury ◽

Poor Performance ◽

Interesting Case ◽

Young Lady ◽

Fluid Replacement ◽

Refractory Shock ◽

Shock Reversal ◽

Dihydropyridine Calcium Channel Blocker ◽

Hypertensive Drug

Amlodipine is a dihydropyridine calcium channel blocker which is widely used as an anti-hypertensive drug. Amlodipine overdose has been infrequently reported with the occurrence of serious complications and even death in a few cases. We report an interesting case of a young lady who presented with refractory shock with acute kidney injury, which did not respond to therapy despite optimal fluid replacement and vasopressor support. The etiology of shock could not be ascertained and the patient was questioned again to elucidate the missing clue in the history. It was finally revealed that the patient had consumed 900 mg of amlodipine in a suicide bid, for her poor performance in academics. The targeted therapy in the form of IV calcium and hyperinsulinemia-euglycemia therapy (HIET) was started and the patient dramatically improved with shock reversal and improvement in renal function.

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Improved Post-Resuscitation Survival Time with Adjuvant Cytosolic Energy Replenishment in a Murine Model of Hemorrhagic Refractory Shock

Journal of Surgery and Anesthesia ◽

10.35248/2684-1606.17.1.109 ◽

2017 ◽

Vol 01 (01) ◽

Cited By ~ 1

Author(s):

El Rasheid Zakaria ◽

Bellal Joseph ◽

Faisal S Jehan ◽

Muhammad Khan ◽

Abdelrahman Algamal ◽

...

Keyword(s):

Survival Time ◽

Murine Model ◽

Refractory Shock ◽

Energy Replenishment

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Characterization of the Human Coronary Microvascular Response to Multiple Hyperaemic Agents

CJC Open ◽

10.1016/j.cjco.2020.09.017 ◽

2020 ◽

Author(s):

Massimo Nardone ◽

Mary McCarthy ◽

Chris I. Ardern ◽

Heather Edgell ◽

Olga Toleva ◽

...

Keyword(s):

Microvascular Response

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Microvascular response to blockade of prostaglandin synthesis in rat skeletal muscle

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1982.243.1.h51 ◽

1982 ◽

Vol 243 (1) ◽

pp. H51-H60 ◽

Cited By ~ 4

Author(s):

J. E. Faber ◽

P. D. Harris ◽

I. G. Joshua

Keyword(s):

Skeletal Muscle ◽

Cremaster Muscle ◽

Local Blood Flow ◽

Local Inhibition ◽

Microvascular Response ◽

Before And After ◽

Endogenous Prostaglandins ◽

The Moment ◽

Arteriolar Tone ◽

Arteriolar Diameter

The contribution of endogenous prostaglandins (PGs) to the control of arteriolar diameter in the microcirculation is incompletely defied and has only been studied in drug-anesthetized animals. To test the possibility that endogenous PGs are tonically released to exert a net dilator influence at certain levels in the microcirculation, television microscopy was used to quantitate the arteriolar responses in the rat cremaster muscle to local blockade of PG synthesis with indomethacin. Rats were decerebrated by a midcollicular transection and were allowed to recover from surgical anesthesia. The cremaster muscle with intact circulation and innervation was suspended by sutures in a temperature-controlled Krebs bath. Diameters, vasomotion frequency, and vasomotion amplitude of arterioles at several anatomic levels were measured before and after local inhibition of PG synthesis in the presence and absence of alpha-adrenergic receptor blockade. Inhibition of PG synthesis produced marked constriction (42-66% of control) at all arteriolar levels, with greater responses occurring in the smaller arterioles. PG synthesis blockade increased vasomotion frequency in arterioles that exhibited spontaneous vasomotion during control periods, and blockade induced vasomotion in vessels lacking spontaneous vasomotion. Pretreatment with phentolamine significantly attenuated the constriction and augmentation of vasomotion. These data indicate that dilator PGs participate in the moment-to-moment regulation of arteriolar tone and local blood flow in skeletal muscle. Further, their mechanism of action may involve alterations in neuronal norepinephrine release or alpha-receptor sensitivity.

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Pulmonary microvascular response to prostacyclin (PGI2) infusion in unanesthetized sheep

Journal of Applied Physiology ◽

10.1152/jappl.1982.52.5.1338 ◽

1982 ◽

Vol 52 (5) ◽

pp. 1338-1342 ◽

Cited By ~ 8

Author(s):

R. Gunther ◽

C. Zaiss ◽

R. H. Demling

Keyword(s):

Cardiac Output ◽

Aortic Pressure ◽

Base Line ◽

Fluid Exchange ◽

Protein Ratio ◽

Microvascular Response ◽

Pulmonary Arterial ◽

Pulmonary Microcirculation ◽

Rebound Increase ◽

Mean Aortic Pressure

We studied the effect of prostacyclin (PGI2) infusion and cessation of infusion on the pulmonary microcirculation. We used lung lymph flow (QL) and the lymph to plasma protein ratio as sensitive indices of net fluid (QF) and protein flux (CP). After a 4-h base line period, we infused PGI2 (0.2 micrograms . kg(-1).min(-1) into eight unanesthetized sheep for 2 h. We monitored vascular pressures and lymph during infusion and for another 18 h after PGI2. During infusion, QL and cardiac output increased by 75 and 50%, respectively, over base line, whereas the lymph-to-plasma ratio (L/P) remained constant for both albumin and globulin. This resulted in a significant increase in both fluid and protein flux. Pulmonary vascular pressures remained unchanged, whereas mean aortic pressure decreased. The increase in QF and CP was felt to be due to an increase in the surface area of fluid exchange vessels rather than increased permeability. After infusion, cardiac output rapidly returned to base line, whereas mean QL remained increased by 70% over base line for 2–8 h. Mean L/P decreased from 0.65 to 0.53. Pulmonary arterial pressure and pulmonary vascular resistance increased. The increase in QL and decrease in L/P indicate a rebound increase in pulmonary microvascular pressure in the postperfusion period.

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Studies of the Hemopoietic Microenvironment. II. Effect of Erythropoietin on the Splenic Microvasculature of Polycythemic CF1 Mice

Blood ◽

10.1182/blood.v39.6.809.809 ◽

1972 ◽

Vol 39 (6) ◽

pp. 809-813 ◽

Cited By ~ 13

Author(s):

Robert S. McCuskey ◽

Howard A. Meineke ◽

Stephen M. Kaplan

Keyword(s):

Stem Cells ◽

Blood Flow ◽

Single Dose ◽

Pancreatic Tissue ◽

Linear Velocity ◽

Hemopoietic Microenvironment ◽

Microvascular Response ◽

Flow Through

Abstract The effect of erythropoietin on the splenic microvascular system of polycythemic CF1 mice was studied using in vivo microscopic methods. Administration of a single dose (3 U) of erythropoietin resulted in an increase in the linear velocity of blood flow through the splenic sinusoids and a reduction in the number of sinusoids storing blood. This response was first seen 4-6 hr after injection; it persisted for 48 hr and was reduced markedly by 72 hr. By 120 hr the spleens were indistinguishable from controls. The response was specific for erythrogenic tissue, since no response was seen in the adjacent nonerythropoietic pancreatic tissue. The results suggest that the splenic microvascular response to erythropoietin may be indirect and may be mediated by the release of a vasoactive metabolite from the erythrogenic tissues surrounding the sinusoids. Erythropoietin-sensitive stem cells are suggested to be the source of such a metabolite.

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