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Background Vasopressors are administered to critically ill patients with vasodilatory shock not responsive to volume resuscitation, and less often in cardiogenic shock, and hypovolemic shock. Objectives The objectives are to review safety and efficacy of vasopressors, pathophysiology, agents that decrease vasopressor dose, predictive biomarkers, [beta]1-blockers, and directions for research. Methods The quality of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results Vasopressors bind adrenergic: [alpha]1, [alpha]2, [beta]1, [beta]2; vasopressin: AVPR1a, AVPR1B, AVPR2; angiotensin II: AG1, AG2; and dopamine: DA1, DA2 receptors inducing vasoconstriction. Vasopressor choice and dose vary because of patients and physician practice. Adverse effects include excessive vasoconstriction, organ ischemia, hyperglycemia, hyperlactatemia, tachycardia, and tachyarrhythmias. No randomized controlled trials of vasopressors showed a significant difference in 28-day mortality rate. Norepinephrine is the first-choice vasopressor in vasodilatory shock after adequate volume resuscitation. Some strategies that decrease norepinephrine dose (vasopressin, angiotensin II) have not decreased 28-day mortality while corticosteroids have decreased 28-day mortality significantly in some (two large trials) but not all trials. In norepinephrine-refractory patients, vasopressin or epinephrine may be added. A new vasopressor, angiotensin II, may be useful in profoundly hypotensive patients. Dobutamine may be added because vasopressors may decrease ventricular contractility. Dopamine is recommended only in bradycardic patients. There are potent vasopressors with limited evidence (e.g. methylene blue, metaraminol) and novel vasopressors in development (selepressin). Conclusions Norepinephrine is first choice followed by vasopressin or epinephrine. Angiotensin II and dopamine have limited indications. In future, predictive biomarkers may guide vasopressor selection and novel vasopressors may emerge., Author(s): James A. Russell [sup.1] Author Affiliations: (1) grid.17091.3e, 0000 0001 2288 9830, Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, , 1081 Burrard Street, Vancouver, [...]

Objective To report the ESICM consensus and clinical practice recommendations on fluid therapy in neurointensive care patients. Design A consensus committee comprising 22 international experts met in October 2016 during ESICM LIVES2016. Teleconferences and electronic-based discussions between the members of the committee subsequently served to discuss and develop the consensus process. Methods Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles generated. The consensus focused on three main topics: (1) general fluid resuscitation and maintenance in neurointensive care patients, (2) hyperosmolar fluids for intracranial pressure control, (3) fluid management in delayed cerebral ischemia after subarachnoid haemorrhage. After an extensive literature search, the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were applied to assess the quality of evidence (from high to very low), to formulate treatment recommendations as strong or weak, and to issue best practice statements when applicable. A modified Delphi process based on the integration of evidence provided by the literature and expert opinions-using a sequential approach to avoid biases and misinterpretations-was used to generate the final consensus statement. Results The final consensus comprises a total of 32 statements, including 13 strong recommendations and 17 weak recommendations. No recommendations were provided for two statements. Conclusions We present a consensus statement and clinical practice recommendations on fluid therapy for neurointensive care patients., Author(s): Mauro Oddo [sup.1], Daniele Poole [sup.2], Raimund Helbok [sup.3], Geert Meyfroidt [sup.4], Nino Stocchetti [sup.5] [sup.6], Pierre Bouzat [sup.7], Maurizio Cecconi [sup.8], Thomas Geeraerts [sup.9], Ignacio Martin-Loeches [sup.10], Hervé [...]

Peripheral artery disease is a severe medical condition commonly characterized by critical or acute limb ischemia. Gradual accumulation of thrombotic plaques in peripheral arteries of the lower limb may lead to intermittent claudication or ischemia in muscle tissue. Ischemic muscle tissue with lesions may become infected, resulting in a non-healing wound. Stable progression of the non-healing wound associated with severe ischemia might lead to functional deterioration of the limb, which, depending on the severity, can result in amputation. Immediate rescue of ischemic muscles through revascularization strategies is considered the gold standard to treat critical limb ischemia. Growth factors offer multiple levels of protection in revascularization of ischemic tissue. In this review, the basic mechanism through which growth factors exert their beneficial properties to rescue the ischemic limb is extensively discussed. Moreover, clinical trials based on growth factor and stem cell therapy to treat critical limb ischemia are considered. The clinical utility of stem cell therapy for the treatment of limb ischemia is explained and recent advances in nanocarrier technology for selective growth factor and stem cell supplementation are summarized. Key words: critical limb, growth factors, ischemia, nanocarriers, stem cell therapy. La maladie arterielle peripherique constitue une affection medicale grave couramment caracterisee par l'ischemie critique ou aigue d'un membre. L'accumulation graduelle de plaques thrombotiques dans les arteres peripheriques des membres inferieurs peut entrainer une claudication intermittente ou une ischemie du tissu musculaire. Le tissu musculaire lese peut s'infecter, ce qui peut causer des plaies qui ne guerissent pas. L'evolution stable de plaies qui ne guerissent pas associee a l'ischemie grave peut mener a une deterioration fonctionnelle du membre, ce qui, dependant de la gravite de l'atteinte, peut entrainer une amputation. On considere que la prise immediate de mesures issues de strategies de revascularisation des muscles ischemiques constitue le traitement de reference de l'ischemie critique des membres. En fait, les facteurs de croissance offrent plusieurs degres de protection dans la revascularisation du tissu ischemique. Dans cet article de synthese, nous discutons en detail des modes d'action qui sous-tendent les proprietes avantageuses des facteurs de croissance dans la prise en charge immediate des membres ischemiques. En outre, nous prenons en compte les essais cliniques fondes sur le traitement de l'ischemie critique des membres avec des facteurs de croissance et des cellules souches. Nous expliquons l'utilite clinique du traitement de l'ischemie des membres avec des cellules souches et nous proposons un resume des avancees recentes de la technologie des nanotransporteurs dans la supplementation selective en facteurs de croissance et en cellules souches. [Traduit par la Redaction] Mots-cles: membre critique, facteurs de croissance, ischemie, nanotransporteurs, traitement fonde sur les cellules souches., Introduction: Peripheral artery disease (PAD) and clinical management PAD is a severe pathological disorder that arises due to blockage of arteries by thrombosis in the lower limbs. PAD is characterized [...]

The aim of this study was to investigate the antioxidant effects of tempol on ovarian ischemia-reperfusion (I/R) injury in rats. Forty female Wistar albino rats were randomly divided into 5 groups: Group I, sham; Group II, ischemia (I); Group III, I/R; Group IV, I/R + tempol 30 mg/kg i.p; Group V, I/R + tempol 50 mg/kg i.p. Oxidative stress index (OSI) was significantly higher in the ischemia group and the I/R group than in the sham group. Catalase levels were significantly lower in the I/R group than in the I/R + tempol 30 mg/kg i.p. and the I/R + tempol 50 mg/kg i.p. groups. Glutathione peroxidase levels were lower in the I/R group than in the I/R + tempol 30 mg/kg i.p. and the I/R + tempol 50 mg/kg i.p. groups. MDA levels were significantly lower in the I/R + tempol 30 mg/kg i.p. group and the I/R + tempol 50 mg/kg i.p. group than in the I/R group. The levels of the histopathological parameters were significantly decreased in the I/R + tempol 50 mg/kg i.p. group compared with the I/R group. Tempol can be used for reducing ovarian I/R injury. Key words: ovarian ischemia-reperfusion, tempol, oxidative stress. Ces travaux avaient pour but d'etudier les effets antioxydants du tempol sur les lesions d'ischemie-reperfusion(I/R) dans l'ovaire chez la rate. Nous avons reparti aleatoirement 40 rates Wistar albinos dans 5 groupes: Groupe I, sham (intervention factice); Groupe II, ischemie; Groupe III, I/R; Groupe IV, I/R + tempol a 30 mg/kg i.p; Group V, I/R + tempol a 50 mg/kg i.p. L'indice de stress oxydatif (ISO) etait nettement plus eleve dans les groupes ischemie et I/R que dans le groupe sham. Les taux de catalase etaient nettement plus bas dans le groupe I/R que dans les groupes I/R + tempol a 30 mg/kg i.p. et I/R + tempol a 50 mg/kg i.p. Les taux de glutathion peroxydase etaient plus bas dans le groupe I/R que dans les groupes I/R + tempol a 30 mg/kg i.p. et I/R + tempol a 50 mg/kg i.p. Les taux de MDA etaient nettement plus bas dans les groupes I/R + tempol a 30 mg/kg i.p. et I/R + tempol a 50 mg/kg i.p. que dans le groupe I/R. Les indices des parametres histopathologiques etaient nettement plus bas dans le groupe I/R + tempol a 50 mg/kg i.p. que dans le groupe I/R. En somme, le tempol peut etre utilise pour attenuer les lesions d'I/R dans l'ovaire. [Traduit par la Redaction] Mots-cles: ischemie-reperfusion dans l'ovaire, tempol, stress oxydatif., Introduction Ovarian torsion is an urgent gynecological event that mostly occurs in women of reproductive age (Oelsner and Shashar 2006). Ovarian torsion has a prevalence of 2.7% in gynecological emergency [...]

Byline: Adina. Hutanu, Mihaela. Iancu, Smaranda. Maier, Rodica. Balasa, Minodora. Dobreanu Objective: Despite advances made in the treatment of ischemic stroke, it still remains one of the leading causes of [...]