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1. How To Write with Style. Power of the Printed Word.

Author

International Paper Co., New York, NY. and Vonnegut, Kurt

Abstract

Elements of a writer's style reveal to readers what sort of a person it is with whom they are spending time. These revelations are important because they are a mark of respect for readers. To develop style, follow these guidelines. Find a subject to care about and which others should care about. It is this caring which will be the most seductive and compelling element of style. Do not ramble. Keep it simple. Remember that two great masters of the language, William Shakespeare and James Joyce, wrote sentences which were almost childlike when their subjects were most profound. Have the guts to cut. If a sentence does not illuminate the subject in a new way, scratch it out. Sound natural. The most natural style for writers is to echo the speech they heard as a child. Say what is meant. If there is something worth saying and understanding, then it must be able to be understood. Pity the readers. They have to make immediate sense of thousands of little marks on paper, an art so difficult that most people don't really master it. For really detailed advice on literary style in a technical sense, see "The Elements of Style," by William Strunk, Jr. and E. B. White. (DC)

Published
1980

2. How To Write a Resume. Power of the Printed Word.

Author

International Paper Co., New York, NY. and Simon, Jerrold G.

Abstract

When conducting a job search, first decide what job area to go after, then find out more about it. Next write a resume. Name, address, and telephone number should go at the top. If the job objective is known exactly, list that next. Now comes work experience; begin with the most recent and work backwards. Don't just list what was done, tell how well it was done. Next, list education. Include high school only if there is no college. If there are no diplomas or degrees, tell about special training programs, courses, or activities. List military service. Now comes personal data, a chance to further the image that has been projected in the preceding sections. Keep the writing style simple and brief. Start sentences with action verbs. Make sure that grammar and spelling are correct and that there are no "typos." Have the resume professionally duplicated. When the resume is ready, track down job openings. Send the resume, along with a cover letter, to a specific person in the company. Arrive early for the interview and follow up with a thank-you note. Keep a list of contacts made and their results. (DC)

Published
1981

3. How To Write Clearly. Power of the Printed Word.

Author

International Paper Co., New York, NY. and Thompson, Edward T.

Abstract

To write well, it is only necessary to write simply and clearly. To learn how, one must want to write clearly, be willing to work hard, and follow some basic guidelines. Before writing, create an outline by arranging ideas on note cards and putting them in a logical sequence. Write to the reader's level of knowledge about the subject. Avoid jargon. Use familiar combinations of words, but retain correct grammar. Use "first-degree" words--words that immediately bring an image to mind. Stick to the points contained in the outline. Be as brief as possible. Here are some ways to condense writing: (1) present points in logical order; (2) don't tell people what they already know; (3) cut out excess evidence and unnecessary anecdotes; (4) avoid word wasters and windy phrases; (5) look for passive verbs that can be made active; (6) look for positive/negative sections from which the negative can be cut; and (7) when finished, stop. (DC)

Published
1979

4. How To Improve Your Vocabulary. Power of the Printed Word.

Author

International Paper Co., New York, NY. and Randall, Tony

Abstract

The following pointers can help people learn and remember new words. First, try to guess the meaning of the word from the way it's used. At least part of a word's meaning can be determined from the context of the sentence. To find out exactly what the word means and where it comes from, look it up in a dictionary. To get at the meaning behind the word, it is necessary to determine its roots. Learning roots: (1) helps with remembering words, (2) gives a deeper understanding of them, and (3) allows the learning of whole families of new words at a time. Another important clue to the meaning of a word is the prefix. There aren't many prefixes and they are easy to learn. Once new words have been learned, they should be put to work immediately. But be careful not to sound like a stuffed shirt; use them when they sound natural. (DC)

Published
1979

5. How To Use a Library. Power of the Printed Word.

Author

International Paper Co., New York, NY. and Michener, James A.

Abstract

To make the most of a library, read and read and read. Here's a sure remedy for the television habit: pile a stack of library books on the television set and next time, instead of turning on a program, reach for a book. Some people limit themselves to reading current bestsellers, but the library is full of yesterday's bestsellers which are still compelling today. Learn to use the card catalog; this is where any book can be found. Learn to use the stacks; unknown books will turn up that are exactly what is needed. Learn to know the reference librarian. Learn to use "The Reader's Guide to Periodical Literature." It is a guide to the latest information on any subject of interest. Four personal hints are: (1) take full notes when using magazines; (2) ask about the availability of reprographic machines; (3) keep a small notebook of identification numbers of frequently used books; and (4) learn how to use the reference books. The library can give help on any subject. Here are a few ideas for fun and rewarding library projects: trace family roots, find out what famous person slept nearby, cook a Polynesian feast, or take up photography. (DC)

Published
1980

6. How To Write a Business Letter. Power of the Printed Word.

Author

International Paper Co., New York, NY. and Forbes, Malcolm

Abstract

Business letters should turn people on rather than turning them off. To write a good business letter, know what the goal is before starting to write, call the reader by name, tell what the letter is about in the first paragraph, refer to dates when answering letters, and write from the reader's point of view. Be positive, be nice, and be natural. Don't be cute or flippant, but don't be afraid to display a sense of humor. Be specific. Lean heavier on nouns and verbs and lighter on adjectives, and use the active voice instead of the passive voice. Make the letter visually appealing. Keep it short, use underlining and indentation for emphasis, and make it perfect. Make the meaning crystal clear, use good English, don't put on airs, don't exaggerate, distinguish opinions from fact, and be honest. Edit ruthlessly. Use the last paragraph to tell the reader what is anticipated as a followup. Close with something simple and sign legibly. (DC)

Published
1981

7. How To Enjoy the Classics. Power of the Printed Word.

Author

International Paper Co., New York, NY. and Allen, Steve

Abstract

A classic is a book that gives the exhilarating feeling that a part of life finally has been uncovered. It is a book that has stood the test of time, that people keep reaching for throughout the ages for its special enlightenment. Here are some suggestions to help open up the world of the classics: (1) know if what is being read is a novel, a drama, a biography, or a history; (2) don't read in bed (classics can be tough going); (3) don't be thrown by a lot of characters; (4) give the author a chance and don't give up on the book too soon; (5) read in big bites; (6) read what the author read; (7) read about the author's time; (8) read about the author's life; and (9) read the book again. The following are a few classics worth trying: Homer's "Iliad" and "Odyssey"; Rabelais's"Gargantua and Pantagruel"; Geoffrey Chaucer's "Canterbury Tales"; Cervantes's "Don Quixote"; Shakespeare's plays, especially "Hamlet,""Macbeth," and "Romeo and Juliet"; Charles Dickens's "Pickwick Papers"; and Mark Twain's "Huckleberry Finn." (DC)

Published
1980

8. How To Enjoy Poetry. Power of the Printed Word.

Author

International Paper Co., New York, NY. and Dickey, James

Abstract

Poetry comes to a person from outside, but for it to live, the person must come to it and meet it and complete it. Poetry is new every day because it is seen in different ways by different people. It makes possible the deepest kind of personal possession of the world. The first true encounter with poetry should be simple and should involve allowing oneself to think and to feel. Part of the spell of poetry is the rhythm of the language. Almost anything put into rhythm and rhyme is more memorable than the same thing said in prose. Writing poetry is a lot like a contest with oneself. Some of the best fun is making up limericks. When the rhymes "pay off," they give a sense of completion and inevitability that is so deliciously memorable that there is nothing else like it. The deeper the encounter wth poetry, the deeper will be the experience of life. Connections between things will exist in ways that they never did before. (DC)

Published
1982

9. How To Read Faster. Power of the Printed Word.

Author

International Paper Co., New York, NY. and Cosby, Bill

Abstract

Three practical ways to get the meaning from printed words quickly and efficiently are: (1) previewing; (2) skimming; and (3) clustering. Previewing and skimming are ways of getting through a lot of reading material without reading every word. Previewing is especially helpful for heavy reading like long articles, business reports, and nonfiction books. When previewing, read the entire first two paragraphs, then read only the first sentence of each successive paragraph, and finally read the entire last two paragraphs. Skimming is good for short, light reading. The reader's eyes should sweep across each line of material, picking up only a few key words in each line. These techniques give a fast, general idea of content. To read faster and understand more, use clustering. Clustering is looking at groups of words instead of one word at a time. This takes constant practice. Pick up something light to read. Concentrate on clustering the first time through, then reread it normally to see what was missed. Practice this 15 minutes every day; it may take a week or more to pick up this technique. (DC)

Published
1981

10. How To Read an Annual Report. Power of the Printed Word.

Author

International Paper Co., New York, NY. and Quinn, Jane Bryant

Abstract

It is helpful to know how to read a company's annual report if an individual is considering going to work for the company, investing in it, or selling to it. When reading an annual report, start at the back with the report of the independent certified public accountant and the footnotes. These can provide information that is not readily apparent from the figures in the report. Next, turn to the letter from the chairman. This should tell how the company fared this year and why, as well as giving insights into the company's future. Now it is time to dig into the numbers. One source is the balance sheet which offers information on the company's assets and liabilities. Important numbers to watch are stockholders' equity, long-term debt, and the ratio between these numbers. A second basic source of numbers is the income statement. The first number to look for here is net sales and the rate at which sales are changing. Watch out for net earnings per share; it can be misleading. Don't be smug about net earnings until finding out what is behind them and what might happen next year. The most important thing of all is to compare the annual report to past reports. (DC)

Published
1981

11. Bulky DNA adducts, 4-aminobiphenyl-haemoglobin adducts and diet in the European Prospective Investigation into Cancer and Nutrition (EPIC) prospective study

Author

Carmen Martinez, Petra H.M. Peeters, Merethe Kumle, Paolo Vineis, Armelle Munnia, Seymour Garte, Bas Bueno-de-Mesquita, Emmanuelle Gormally, Ole Raaschou-Nielsen, Antonio Agudo, Giuseppe Matullo, Bengt Järvholm, Françoise Clavel-Chapelon, José Ramón Quirós, Göran Berglund, Marco Peluso, Alison M. Dunning, Rosario Tumino, Alessandro Colombi, Salvatore Panico, Timothy J. Key, Luisa Airoldi, Elio Riboli, S Bingham, Fabrizio Veglia, Rudolf Kaaks, Antonia Trichopoulou, Aurelio Barricarte, Vittorio Krogh, Christian Malaveille, Nicholas E. Day, Kim Overvad, Rodolfo Saracci, Herman Autrup, María José Tormo, Domenico Palli, J. Linseisen, Heiner Boeing, Miren Dorronsoro, Faculteit Medische Wetenschappen/UMCG, Peluso, M, Airoldi, L, Munnia, A, Colombi, A, Veglia, F, Autrup, H, Dunning, A, Garte, S, Gormally, E, Malaveille, C, Matullo, G, Overvad, K, Raaschou Nielsen, O, Clavel Chapelon, F, Linseisen, J, Boeing, H, Trichopoulou, A, Palli, D, Krogh, V, Tumino, R, Panico, Salvatore, Bueno De Mesquita, Bh, Peeters, Ph, Kumle, M, Agudo, A, Martinez, C, Dorronsoro, M, Barricarte, A, Tormo, Mj, Quiros, Jr, Berglund, G, Jarvholm, B, Day, Ne, Key, Tj, Saracci, R, Kaaks, R, Riboli, E, Bingham, S, Vineis, P., [Peluso,M, Munnia, A] Cancer Risk Factor Branch, Analytical and Biomolecular Cytology Unit, CSPO-Scientific Institute of Tuscany, Florence, Italy. [Airoldi,L, Colombi,A] Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. [Veglia, F, Matullo,G] ISI Foundation, Turin, Italy. [Autrup,H] Department of Environmental and Occupational Medicine, Aarhus, Denmark. [Dunning, A] Department of Oncology, University of Cambridge, Cambridge, UK. [Garte,S] Genetics Research Institute, Milan, Italy. [Gormally,E, Malaveille,C] International Agency for Research on Cancer, Lyon, France. [Overhad,K] Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark. [Raaschou-Nielsen,O] Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark. [Clavel-Chapelon,F] INSERM (Institut National de la Sante´ et de la Recherche Me´dicale), ERI 20, EA 4045, and Institut Gustave Roussy, Villejuif, F-94805, France. [Linseisen,J] Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, German. [Boeing,H] German Institute of Human Nutrition, Potsdam-Rehbu¨cke, Germany. [Trichopoulou,A] Department of Hygiene and Epidemiology, Medical School, University of Athens, Athens, Greece. [Palli,D] Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Cancer Prevention Tuscany Region, Florence, Italy. [Krogh,V] Department of Epidemiology, National Cancer Institute, Milan, Italy. [Tumino,R] Cancer Registry, Azienda Ospedaliera ‘Civile MP Arezzo’, Ragusa, Ital. [Panico,S] Dipartimento di Medicina Clinica e Sperimentale, Universita` Federico II, Naples, Italy. [Bueno-De-Mesquita,BH] Centre for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherland. [Peeters,PH] Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands. [Kumle,M] Institute of Community Medicine, University of Tromso, Tromso, Norway. [Agudo,A] Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain. [Martinez,C] Andalusian School of Public Health, Granada, Spain. [Dorronsoro,M] Department of Public Health of Guipuzkoa, San Sebastian, Spain. [Barricarte,A] Public Health Institute, Navarra, Spain. [Tormo,MJ] Epidemiology Department, Murcia Health Council, Murcia, Spain. Quiros, JR] Direccio´n General de Salud Pu´blica, Consejerı´a de Salud y Servicios Sanitarios Asturias, Oviedo, Spain. [Berglund,G] Malmo¨ Diet and Cancer Study, Lund University, Malmo¨, Sweden. [Jarvholm,G] Department of Nutritional Research, University of Umea˚, Umea˚ , Sweden. [Day,ND, Bingham,S] MRC Dunn Human Nutrition Unit, Cambridge University, UK. [Key,TJ].Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, UK. [Saracci,R] IFC National Research Council, Pisa, Italy. [Kaas,R] Division of Epidemiology, DKFZ Heidelberg, Germany. [Riboli,E] Imperial College London, London, UK. [Vineis,P] University of Turin, Turin, Italy. Department of Epidemiology and Public Health, Imperial College of Science, Technology and Medicine, Norfolk Place, London W2 1PG, UK, This paper was made possible by a grant of the European Community (5th Framework Programme) to P. V. (grant QLK4–CT–1999–00 927) and a grant of the Compagnia di San Paolo to the ISI Foundation. All authors are independent from funders. Mortality data for the Netherlands were obtained from Statistics Netherlands. Also, the work described in the paper was carried out with the financial support of: Europe Against Cancer Program of the European Commission (SANCO), ISCIII, Red de Centros RCESP, C03/09, Deutsche Krebshilfe, Deutsches Krebsforschungszentrum, German Federal Ministry of Education and Research, Danish Cancer Society, Health Research Fund (FIS) of the Spanish Ministry of Health, Spanish Regional Governments of Andalucia, Asturias, Basque Country, Murcia and Navarra, Cancer Research UK, Medical Research Council, UK, Stroke Association, UK, British Heart Foundation, Department of Health, UK, Food Standards Agency, UK, Wellcome Trust, UK, Greek Ministry of Health, Greek Ministry of Education, Italian Association for Research on Cancer (AIRC), Italian National Research Council, Dutch Ministry of Public Health, Welfare and Sports, World Cancer Research Fund, Swedish Cancer Society, Swedish Scientific Council, Regional Government of Ska°ne, Sweden, Norwegian Cancer Society, and Research Council of Norway.

Subjects
Dietary Fiber, Male, Aflatoxin, Erythrocytes, Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Hemoglobins [Medical Subject Headings], medicine.medical_treatment, air pollution, RESISTANT STARCH, Medicine (miscellaneous), GUIDELINES, Carcinógenos, Body Mass Index, COLORECTAL-CANCER, Food group, chemistry.chemical_compound, Hemoglobins, Vegetables, Chemicals and Drugs::Chemical Actions and Uses::Toxic Actions::Environmental Pollutants::Air Pollutants [Medical Subject Headings], Leukocytes, Aductos de ADN, Nutritional Physiological Phenomena, Food science, Prospective Studies, RISK, DNA adducts, Haemoglobin adducts, Non-smokers, Fibre intake, Air pollution, Publication Characteristics::Study Characteristics::Multicenter Study [Medical Subject Headings], Air Pollutants, Nutrition and Dietetics, Chemistry, Technology, Industry, Agriculture::Food and Beverages::Food::Dietary Fiber [Medical Subject Headings], Chemicals and Drugs::Chemical Actions and Uses::Toxic Actions::Noxae::Carcinogens [Medical Subject Headings], COLON-CANCER, Phenomena and Processes::Genetic Phenomena::Genetic Processes::DNA Damage::DNA Adducts [Medical Subject Headings], Fabaceae, Middle Aged, fibre intake, European Prospective Investigation into Cancer and Nutrition, Europe, Biochemistry, 4-Aminobiphenyl, Colonic Neoplasms, Hemoglobinas, Female, SMOKERS, Alcohol Drinking, BLADDER-CANCER, European Prospective Investigation into Cancer and Nutrition (EPIC), haemoglobin adducts, non-smokers, RATS, POLYCYCLIC AROMATIC-HYDROCARBONS, Ozone, LUNG-CANCER, DNA adduct, medicine, Humans, Contaminantes del aire, ddc:610, Carcinogen, Aged, Estudio multicéntrico, Vitamin E, Fruit, Multivariate Analysis, Fibras en la dieta, Carcinogens, Biomarkers, Food contaminant
Abstract

Udgivelsesdato: 2008-Feb-14 In contrast to some extensively examined food mutagens, for example, aflatoxins, N-nitrosamines and heterocyclic amines, some other food contaminants, in particular polycyclic aromatic hydrocarbons (PAH) and other aromatic compounds, have received less attention. Therefore, exploring the relationships between dietary habits and the levels of biomarkers related to exposure to aromatic compounds is highly relevant. We have investigated in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort the association between dietary items (food groups and nutrients) and aromatic DNA adducts and 4-aminobiphenyl-Hb adducts. Both types of adducts are biomarkers of carcinogen exposure and possibly of cancer risk, and were measured, respectively, in leucocytes and erythrocytes of 1086 (DNA adducts) and 190 (Hb adducts) non-smokers. An inverse, statistically significant, association has been found between DNA adduct levels and dietary fibre intake (P = 0.02), vitamin E (P = 0.04) and alcohol (P = 0.03) but not with other nutrients or food groups. Also, an inverse association between fibre and fruit intake, and BMI and 4-aminobiphenyl-Hb adducts (P = 0.03, 0.04, and 0.03 respectively) was observed. After multivariate regression analysis these inverse correlations remained statistically significant, except for the correlation adducts v. fruit intake. The present study suggests that fibre intake in the usual range can modify the level of DNA or Hb aromatic adducts, but such role seems to be quantitatively modest. Fibres could reduce the formation of DNA adducts in different manners, by diluting potential food mutagens and carcinogens in the gastrointestinal tract, by speeding their transit through the colon and by binding carcinogenic substances.

Published
2008

12. Current use of inotropes in circulatory shock

Author

Michael R. Pinsky, Maria Cronhjort, Thomas Kaufmann, Rupert M Pearse, Ludhmila Abrahão Hajjar, Daniel A. Reuter, Jean Louis Vincent, Daniel De Backer, Martin W. Dünser, Maurizio Cecconi, Xavier Monnet, Iwan C. C. van der Horst, Vanina Siham Kanoore Edul, Bernard Cholley, Claude Martin, Thomas Scheeren, Yasser Sakr, Philippe Vignon, Didier Payen, Olfa Hamzaoui, Bernd Saugel, E. Christiaan Boerma, Pierre Squara, Alexandre Mebazaa, Geert Koster, Djillali Annane, Andrea Morelli, Arnaldo Dubin, Marc Leone, Pierre Asfar, Mervyn Singer, Anthony C. Gordon, Jan Bakker, Antoine Vieillard-Baron, Giovanni Landoni, Michael Sander, Michelle S Chew, Jean-Louis Teboul, Simon T. Vistisen, Glenn Hernandez, Peter Radermacher, Jacques Duranteau, Bruno Levy, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), RS: Carim - V04 Surgical intervention, Intensive Care, MUMC+: MA Medische Staf IC (9), MUMC+: MA Intensive Care (3), University of Groningen [Groningen], University Medical Center Groningen [Groningen] (UMCG), New York University Langone Medical Center (NYU Langone Medical Center), NYU System (NYU), Columbia University Medical Center (CUMC), Columbia University [New York], Erasmus University Medical Center [Rotterdam] (Erasmus MC), Hôpital Raymond Poincaré [AP-HP], Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Medical Centre Leeuwarden, Istituto Clinico Humanitas [Milan] (IRCCS Milan), Humanitas University [Milan] (Hunimed), Linköping University (LIU), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université Paris Cité - UFR Médecine [Santé] (UPCité UFR Médecine), Université Paris Cité (UPCité), Karolinska Institutet [Stockholm], Centre Hospitalier Interrégional Edith Cavell (CHIREC), Universidad Nacional de la Plata [Argentine] (UNLP), Johannes Kepler University Linz [Linz] (JKU), Kepler University Hospital, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Imperial College London, Universidade de São Paulo = University of São Paulo (USP), AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Pontificia Universidad Católica de Chile (UC), Hospital Juan A. Fernandez [Buenos Aires, Argentina], Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie] (UniSR), Hôpital Nord [CHU - APHM], Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département d’Anesthésie-Réanimation-SMUR [Hôpital Lariboisière], Hôpitaux Universitaire Saint-Louis, Lariboisière, Fernand-Widal, Centre de Référence de l’Hypertension Pulmonaire Sévère [CHU Le Kremlin Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Ecotaxie, microenvironnement et développement lymphocytaire (EMily (UMR_S_1160 / U1160)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Hôpital Lariboisière-Fernand-Widal [APHP], William Harvey Research Institute, Barts and the London Medical School, Queen Mary University of London (QMUL), University of Pittsburgh Medical Center [Pittsburgh, PA, États-Unis] (UPMC), Universitätsklinikum Ulm - University Hospital of Ulm, University Medical Center Rostock, Jena University Hospital [Jena], Justus-Liebig-Universität Gießen = Justus Liebig University (JLU), Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), University College of London [London] (UCL), Clinique Ambroise Paré [Centres Médico-Chirurgicaux Ambroise Pré, Pierre Cherest, Hartmann], Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Centre d'Investigation Clinique de Limoges (CIC1435), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM), Université libre de Bruxelles (ULB), Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Aarhus University Hospital, European Society of Intensive Care Medicine, ESICM, This work has received the endorsement of the European Society of Intensive Care Medicine. The authors would like to thank Hannah Wunsch and Anders Perner, who provided their expertise as experts but abstained from being listed as co-author of this paper., HAL UVSQ, Équipe, NIHR, Scheeren, T. W. L., Bakker, J., Kaufmann, T., Annane, D., Asfar, P., Boerma, E. C., Cecconi, M., Chew, M. S., Cholley, B., Cronhjort, M., De Backer, D., Dubin, A., Dunser, M. W., Duranteau, J., Gordon, A. C., Hajjar, L. A., Hamzaoui, O., Hernandez, G., Kanoore Edul, V., Koster, G., Landoni, G., Leone, M., Levy, B., Martin, C., Mebazaa, A., Monnet, X., Morelli, A., Payen, D., Pearse, R. M., Pinsky, M. R., Radermacher, P., Reuter, D. A., Sakr, Y., Sander, M., Saugel, B., Singer, M., Squara, P., Vieillard-Baron, A., Vignon, P., Vincent, J. -L., van der Horst, I. C. C., Vistisen, S. T., and Teboul, J. -L.

Subjects
Inotrope, PDE-inhibitors, Levosimendan, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, GUIDELINES, 0302 clinical medicine, Catecholamines, CARDIAC-OUTPUT SYNDROME, Septic shock, Inotropes, Cardiogenic shock, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Acute circulatory failure, 3. Good health, [SDV] Life Sciences [q-bio], Shock (circulatory), Sepsis, Resuscitation, Vasoactive agents, Cardiac output, medicine.symptom, Life Sciences & Biomedicine, CRITICALLY-ILL PATIENTS, medicine.drug, medicine.medical_specialty, Anestesi och intensivvård, Medicina, Context (language use), VASOPRESSORS, 1117 Public Health and Health Services, 03 medical and health sciences, Critical Care Medicine, acute circulatory failure, cardiac output, cardiogenic shock, catecholamines, inotropes, levosimendan, resuscitation, sepsis, septic shock, vasoactive agents, General & Internal Medicine, Anesthesiology, medicine, Intensive care medicine, METAANALYSIS, Science & Technology, Anesthesiology and Intensive Care, business.industry, Research, 1103 Clinical Sciences, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Guideline, medicine.disease, DYSFUNCTION, CARDIOGENIC-SHOCK, Dobutamine, business
Abstract

Background: Treatment decisions on critically ill patients with circulatory shock lack consensus. In an international survey, we aimed to evaluate the indications, current practice, and therapeutic goals of inotrope therapy in the treatment of patients with circulatory shock. Methods: From November 2016 to April 2017, an anonymous web-based survey on the use of cardiovascular drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 14 questions focused on the profile of respondents, the triggering factors, first-line choice, dosing, timing, targets, additional treatment strategy, and suggested effect of inotropes. In addition, a group of 42 international ESICM experts was asked to formulate recommendations for the use of inotropes based on 11 questions. Results: A total of 839 physicians from 82 countries responded. Dobutamine was the first-line inotrope in critically ill patients with acute heart failure for 84% of respondents. Two-thirds of respondents (66%) stated to use inotropes when there were persistent clinical signs of hypoperfusion or persistent hyperlactatemia despite a supposed adequate use of fluids and vasopressors, with (44%) or without (22%) the context of low left ventricular ejection fraction. Nearly half (44%) of respondents stated an adequate cardiac output as target for inotropic treatment. The experts agreed on 11 strong recommendations, all of which were based on excellent (> 90%) or good (81–90%) agreement. Recommendations include the indications for inotropes (septic and cardiogenic shock), the choice of drugs (dobutamine, not dopamine), the triggers (low cardiac output and clinical signs of hypoperfusion) and targets (adequate cardiac output) and stopping criteria (adverse effects and clinical improvement). Conclusion: Inotrope use in critically ill patients is quite heterogeneous as self-reported by individual caregivers. Eleven strong recommendations on the indications, choice, triggers and targets for the use of inotropes are given by international experts. Future studies should focus on consistent indications for inotrope use and implementation into a guideline for circulatory shock that encompasses individualized targets and outcomes., La lista completa de autores que integran el documento puede consultarse en el archivo., Facultad de Ciencias Médicas

Published
2020