Vasoactive Drugs for Septic Shock: Where are we now?

Introdução: A angina de Plaut-Vincent é uma afecção úlcero-necrótica causada pela simbiose de um bacilo fusiforme (Fusobacterium necrophorum) e um espirilo (Borrelia vincenti). Ambos são agentes saprófitas habituais da cavidade oral, porém, quando associados, determinam o caráter patogênico da doença. Casuística: Trata-se do caso de uma paciente do sexo feminino, 4 anos de idade, que deu entrada no pronto socorro com choque séptico descompensado não responsivo a volume com necessidade de drogas vasoativas (DVA), além de má conservação dentária, e amigdalas necrosadas. Em 48h evoluiu com piora hemodinâmica refratária a DVA e introdução de hidrocortisona, com crises convulsivas e hemiplegia à esquerda. Foi solicitada TC crânio a qual evidenciou AVC isquêmico. Discussão: Ocorre geralmente em condições de desnutrição e má higiene oral, tendo sua maior incidência entre os adultos-jovens e adolescentes. Cursa com necrose das amigdalas, halitose intensa e disfagia. Conclusão: Considerando que a Angina de Plaut-Vincent acomete principalmente adultos jovens, torna-se de grande relevância relatar o caso de uma paciente pediátrica, que evoluiu de forma incomum, apresentando lesões isquêmicas cerebrovasculares. Palavras-chave: amigdalite, isquemia cerebral, choque séptico, angina. ABSTRACT Introduction: Plaut–Vincent’s angina is an ulcer-necrotic disease caused by the symbiosis of a fusiform bacillus (Fusobacterium necrophorum) and spirillum (Borrelia vincenti). Both are common saprophytic agents of the oral cavity, but when combined determine the pathogenic of the disease. Case report: We describe the case of a female patient, 4 years old, which gave entered the emergency room with decompensated septic shock unresponsive to volume in the need of vasoactive drugs (DVA), moreover poor dental conservation and necrotic tonsils. After 48h evolved with hemodynamic deterioration refractory to VAD and insertion of hydrocortisone, with convulsion and left hemiplegia. A cranial CT was requested and revealed ischemic stroke. Discussion: Usually occurs in conditions of malnutrition and poor oral hygiene and has a high incidence among the young adults and adolescents. Courses with necrosis of the tonsils, severe halitosis and dysphagia. Conclusion: Whereas the Plaut-Vincent Angina affects mainly young adults, it is extremely important to report the case of a pediatric patient that led in an unusual way, with cerebrovascular ischemic lesions. Keywords: tonsillitis, cerebral ischemia, septic shock, angina.

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Early Fluid Resuscitation and High Volume Hemofiltration Decrease Septic Shock Progression in Swine

BioMed Research International ◽

10.1155/2015/181845 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Ping Zhao ◽

Ruiqiang Zheng ◽

Lu Xue ◽

Min Zhang ◽

Xiaoyan Wu

Keyword(s):

Septic Shock ◽

Fluid Intake ◽

High Volume ◽

Left Ventricular ◽

Swine Model ◽

Ventricular Contractility ◽

Vasoactive Drugs ◽

High Volume Hemofiltration ◽

Early Fluid ◽

Partial Oxygen

This study aimed to assess the effects of early fluid resuscitation (EFR) combined with high volume hemofiltration (HVHF) on the cardiopulmonary function and removal of inflammatory mediators in a septic shock swine model. Eighteen swine were randomized into three groups: control(n=6)(extracorporeal circulating blood only), continuous renal replacement therapy (CRRT) (n=6; ultrafiltration volume = 25 mL/Kg/h), and HVHF (n=6; ultrafiltration volume = 85 mL/Kg/h). The septic shock model was established by intravenous infusion of lipopolysaccharides (50 µg/kg/h). Hemodynamic parameters (arterial pressure, heart rate, cardiac output, stroke volume variability, left ventricular contractility, systemic vascular resistance, and central venous pressure), vasoactive drug parameters (dose and time of norepinephrine and hourly fluid intake), pulmonary function (partial oxygen pressure and vascular permeability), and cytokines (interleukin-6 and interleukin-10) were observed. Treatment resulted in significant changes at 4–6 h. HVHF was beneficial, as shown by the dose of vasoactive drugs, fluid intake volume, left ventricular contractility index, and partial oxygen pressure. Both CRRT and HVHF groups showed improved removal of inflammatory mediators compared with controls. In conclusion, EFR combined with HVHF improved septic shock in this swine model. The combination decreased shock progression, reduced the need for vasoactive drugs, and alleviated the damage to cardiopulmonary functions.

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First-Line Vasoactive Drugs for Pediatric Septic Shock

Critical Care Medicine ◽

10.1097/ccm.0000000000001511 ◽

2016 ◽

Vol 44 (4) ◽

pp. e232-e233 ◽

Cited By ~ 1

Author(s):

José Colleti ◽

Werther Brunow de Carvalho

Keyword(s):

Septic Shock ◽

Vasoactive Drugs ◽

First Line

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Effects of vasoactive drugs on hepatic and intestinal circulation and intestinal barrier in patients with septic shock

Journal of Investigative Medicine ◽

10.1136/jim-2020-001685 ◽

2021 ◽

pp. jim-2020-001685

Author(s):

Jie Liu ◽

Min Zheng ◽

Xu Zhao ◽

Yong-Jiu Zha ◽

Hu-Nian Li ◽

...

Keyword(s):

Septic Shock ◽

Intestinal Barrier ◽

Blood Lipid ◽

Effective Rate ◽

Control Group ◽

Vasoactive Drugs ◽

Junction Protein ◽

Significant Difference ◽

Experimental Group ◽

Intestinal Circulation

In this study, 60 patients with septic shock were selected over the course of 1 year, and the effects of dopamine and norepinephrine combined with dobutamine on hepatic and intestinal circulation and intestinal barrier in patients with septic shock were studied by comparison between the control group and the experimental group. All patients received mechanical ventilation to maintain breathing at 14 to 20 times/min. The experimental group was treated with vascular active drugs after adequate rehydration, and the control group only received adequate rehydration. There were extremely significant differences (p<0.01) in the total effective rate of each group. There were significant differences in the hemodynamic indexes in each group (p<0.05). There was a significant difference in total 24-hour bile output (p<0.01). There were significant differences in liver function and blood lipid values in patients (p<0.01). There were significant differences in the repair of epithelial injury at 0 hour, 48 hours and 96 hours (p<0.01). There were significant differences in the transmembrane resistance of monolayer cells (p<0.01). The expression differences of three proteins ZO-1, occludin and β-actin were also significant, among which the three proteins in the control group were weak, while those in groups A and B were strong. The expression of tight junction protein in monolayer cells was weakly positive in expression and strong in other proteins. In conclusion, vasoactive drugs had significant effects on hepatic and intestinal circulation and intestinal barrier in patients with septic shock.

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