cardiovascular-agents and Multiple-Organ-Failure

Muscular fatigue and dyspnoea on exertion are among the most common symptoms in chronic heart failure; however their origin is still poorly understood. Several studies have shown that cardiac dysfunction alone cannot fully explain their origin, but the contribution of the multiorgan failure present in this syndrome must be highlighted. We aimed to summarize the existing evidence and the most controversial aspects of the complex interplay of different factors involved in the symptom generation. In the first part of the review, six key factors were revised (the heart, the lung, the skeletal muscle, the hormonal changes, the O2 delivery to the periphery, the endothelium). In this second part, the role of the excitatory reflexes and the cardiac cachexia are presented. Finally, potential therapeutic implications are discussed here. We believe that a better knowledge of the pathophysiology of this syndrome may contribute to the management of the patients and to the improvement in their stress tolerance and quality of life.

Topics: Cachexia; Cardiac Resynchronization Therapy; Cardiovascular Agents; Chronic Disease; Dyspnea; Exercise Tolerance; Heart Failure; Humans; Multiple Organ Failure; Muscle Fatigue; Reflex; Treatment Outcome

Topics: Cardiovascular Agents; Combined Modality Therapy; Critical Care; Energy Metabolism; Heart Failure; Hemodynamics; Humans; Monitoring, Physiologic; Multiple Organ Failure; Postoperative Complications

A heart rate higher than 90 beats/min indicates an unfavorable prognosis for patients with multiple organ dysfunction syndrome (MODS). We sought to investigate the effect of the pacemaker current (If) inhibitor ivabradine on heart rate, hemodynamics, and disease severity among patients with MODS.. In this prospective, controlled, randomized, open-label, two-arm phase II trial, 70 patients with MODS, a sinus rhythm of at least 90 beats/min, and contraindications to β-blocker therapy were randomly assigned to receive the standard treatment ± ivabradine (5 mg twice daily) for 96 h via the enteral route. The primary outcome was the percentage of patients with a heart rate reduction of at least 10 beats/min after 96 h. Secondary outcomes included the effect of ivabradine on hemodynamics, disease severity, vasopressor use, mortality, and adverse events.. There were no significant differences in the primary outcome between the ivabradine and control groups (P = 0.147). After 96 h, the daily median heart rate was reduced by 7 beats/min in the control group and by 16 beats/min in the ivabradine group (P = 0.014). No differences in secondary outcomes were observed.. The number of critically ill patients with MODS and a sinus rhythm of at least 90 beats/min that experienced a heart rate reduction of at least 10 beats/min after oral ivabradine treatment did not differ significantly between groups. The moderate but significant reduction of heart rate by 7 beats/min did not affect hemodynamics or disease severity.

Topics: Adrenergic beta-Antagonists; Aged; Cardiovascular Agents; Female; Heart Rate; Hemodynamics; Humans; Ivabradine; Middle Aged; Multiple Organ Failure

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. As such, circulating cytokines and danger- and pathogen-associated molecular patterns (such as endotoxins) are recognized as central in the pathogenesis of sepsis and organ dysfunction. Removing these compounds by extracorporeal blood filtration, commonly considered blood purification, may improve the septic patients' condition. This study aimed to assess the vaso-inotropic support evolution over time in pediatric patients with vasoplegic shock treated with oXiris©.. All patients aged below 18 years admitted at the Paris Saclay University Quaternary Pediatric Intensive Care Unit with vasoplegic shock and acute kidney injury and treated with oXiris© between October 2017 and January 2020 were included. The vaso-inotropic score and the 28-day mortality were assessed. Improvement under treatment was defined as a 50% decrease in the vaso-inotropic score following 24 h of oXiris© therapy.. Eleven pediatric patients aged 2-15 years and weighing 11-60 kg were admitted with vasoplegic shock and acute kidney injury. They received thirteen sessions of oXiris© therapy for septic shock (N = 7) and liver failure (N = 6). Eight patients did not improve their condition during the session, and five ultimately died (37.5% survival). Five patients improved, decreasing their inotropic support by >50% in 24 h. Among them, four survived (80%).. Hemofiltration and extracorporeal blood purification with oXiris© can be used in pediatric patients with vasoplegic shock with rapid improvement in hemodynamics in selected patients.

Topics: Acute Kidney Injury; Adolescent; Cardiovascular Agents; Child; Child, Preschool; Critical Illness; Humans; Multiple Organ Failure; Sepsis; Shock, Septic

Endomyocardial fibrosis (EMF) is a rare condition and a major cause of death in tropical countries. The etiology of EMF remains elusive, and no specific treatment has been developed yet, therefore it carries poor prognosis.. An 81-year-old male Chinese patient with a history of long-standing exertional breathlessness, presented with worsening symptoms rapidly evolving to orthopnea. A proper specific treatment was prescribed to the patient in the following days, including diuretics, angiotensin-converting-enzyme inhibitor and beta blockers. The patient died of progressive multiple organ failure.. Echocardiography is technically limited due to the acoustic shadowing as a result of the calcification. Chest computed tomography is a more accurate diagnostic tool to examine the anatomic distribution and extent of endomyocardial calcification in this rare case.

Topics: Aged, 80 and over; Cardiovascular Agents; China; Disease Progression; Dyspnea; Echocardiography; Endomyocardial Fibrosis; Fatal Outcome; Humans; Male; Multiple Organ Failure; Predictive Value of Tests; Tomography, X-Ray Computed; Treatment Outcome

Successful resuscitation from cardiac arrest results in a post-cardiac arrest syndrome, which can evolve in the days to weeks after return of sustained circulation. The components of post-cardiac arrest syndrome are brain injury, myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating pathophysiology. Pediatric post-cardiac arrest care focuses on anticipating, identifying, and treating this complex physiology to improve survival and neurological outcomes. This scientific statement on post-cardiac arrest care is the result of a consensus process that included pediatric and adult emergency medicine, critical care, cardiac critical care, cardiology, neurology, and nursing specialists who analyzed the past 20 years of pediatric cardiac arrest, adult cardiac arrest, and pediatric critical illness peer-reviewed published literature. The statement summarizes the epidemiology, pathophysiology, management, and prognostication after return of sustained circulation after cardiac arrest, and it provides consensus on the current evidence supporting elements of pediatric post-cardiac arrest care.

Topics: Acute Kidney Injury; Adrenal Insufficiency; Anticonvulsants; Brain Damage, Chronic; Cardiomyopathies; Cardiopulmonary Resuscitation; Cardiovascular Agents; Child; Combined Modality Therapy; Fluid Therapy; Glucose Metabolism Disorders; Heart Arrest; Humans; Hypnotics and Sedatives; Hypothermia, Induced; Hypoxia-Ischemia, Brain; Infections; Inflammation; Monitoring, Physiologic; Multiple Organ Failure; Neuromuscular Blocking Agents; Oxygen Inhalation Therapy; Prognosis; Reperfusion Injury; Respiratory Therapy; Time Factors

Overdose of cardiovascular medications is increasingly associated with morbidity and mortality. We present a case of substantial atenolol, chlorthalidone, and lisinopril overdose treated by multiple modalities with an excellent outcome.. Aggressive medical intervention did not provide sufficient hemodynamic stability in this patient with refractory cardiogenic and distributive shock. Impella® percutaneous left ventricular assist device and extracorporeal membrane oxygenation provided support while the effects of the overdose subsided. We present concentrations demonstrating removal of atenolol with continuous venovenous hemodiafiltration. This is the first report of esophagogastroduo denoscopy decontamination of this overdose with a large pill fragment burden.

Topics: Adrenergic beta-1 Receptor Antagonists; Adult; Atenolol; Cardiovascular Agents; Chlorthalidone; Combined Modality Therapy; Decontamination; Drug Overdose; Emergency Service, Hospital; Endoscopy, Digestive System; Extracorporeal Membrane Oxygenation; Female; Humans; Lisinopril; Multiple Organ Failure; Renal Dialysis; Shock, Cardiogenic; Tablets; Transcutaneous Electric Nerve Stimulation; Treatment Outcome

Topics: Aged; Arrhythmias, Cardiac; Benzazepines; Cardiovascular Agents; Humans; Ivabradine; Male; Middle Aged; Multiple Organ Failure; Pilot Projects; Sepsis; Treatment Outcome

We present three cases of pediatric patients with thrombocytopenia-associated multiple organ failure and the evidence for providing extracorporeal organ support. All three patients had severe cardiac dysfunction, respiratory failure, and acute kidney injury treated with venoarterial extracorporeal membrane oxygenation, continuous renal replacement therapy, and plasma exchange. Despite the presence of multiple organ failure and high risk of mortality, all three patients survived with minimal long-term sequelae.

Topics: ADAM Proteins; ADAMTS13 Protein; Adolescent; Bacteremia; Cardiopulmonary Resuscitation; Cardiovascular Agents; Child; Combined Modality Therapy; Extracorporeal Membrane Oxygenation; Fluid Therapy; Heart Arrest; Hemofiltration; Hemolytic-Uremic Syndrome; High-Frequency Ventilation; Humans; Infarction, Middle Cerebral Artery; Influenza A virus; Influenza, Human; Male; Methicillin-Resistant Staphylococcus aureus; Multiple Organ Failure; Osteomyelitis; Plasma Exchange; Staphylococcal Infections; Thrombotic Microangiopathies; Tracheostomy

The objective of this study was to determine the effects of a TREM (triggering receptor expressed on myeloid cells 1)-like transcript 1-derived peptide (LR12) administration during septic shock in pigs. Two hours after induction of a fecal peritonitis, anesthetized and mechanically ventilated adult male minipigs were randomized to receive LR12 (n = 6) or its vehicle alone (normal saline, n = 5). Two animals were operated and instrumented without the induction of peritonitis and served as controls (sham). Resuscitation was achieved using hydroxyethyl starch (up to 20 mL/kg) and norepinephrine infusion (up to 10 μg/kg per minute). Hemodynamic parameters were continuously recorded. Gas exchange, acid-base status, organ function, and plasma cytokines concentrations were evaluated at regular intervals until 24 h after the onset of peritonitis when animals were killed under anesthesia. Peritonitis induced profound hypotension, myocardial dysfunction, lactic acidosis, coagulation abnormalities, and multiple organ failure. These disorders were largely attenuated by LR12. In particular, cardiovascular failure was dampened as attested by a better mean arterial pressure, cardiac index, cardiac power index, and S(v)O(2), despite lower norepinephrine requirements. LR12, a TREM-like transcript 1-derived peptide, exhibits salutary properties during septic shock in adult minipigs.

Topics: Animals; Blood Coagulation Disorders; Cardiovascular Agents; Cardiovascular Diseases; Hemodynamics; Hydroxyethyl Starch Derivatives; Hypotension; Male; Multiple Organ Failure; Random Allocation; Receptors, Immunologic; Shock, Septic; Swine; Swine, Miniature

Topics: Biopsy; Cardiac Resynchronization Therapy; Cardiomyopathies; Cardiovascular Agents; Defibrillators, Implantable; Electric Countershock; Electrocardiography; Fatal Outcome; Female; Heart Failure; Humans; Hydroxychloroquine; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Middle Aged; Multiple Organ Failure; Treatment Outcome

Amniotic fluid embolism (AFE) is a rare, but often catastrophic, complication of pregnancy and associated with severe coagulopathy. We present an algorithm-based approach in managing coagulopathy and hemorrhage in a fatal case of histopathologically proven AFE. Thrombelastometry was used for rapid evaluation of the coagulation status. Stop of extensive hyperfibrinolysis with tranexamic acid, stabilization of initial clot formation with high-dose fibrinogen and platelet transfusions, and use of prothrombin complex concentrate together with a 1: 1 transfusion regimen of red packed cells and fresh frozen plasma was successful to control diffuse bleeding and restore clot firmness after hysterectomy. Stable clotting situation was maintained despite further clinical deterioration and development of multiple organ failure in this patient.

Topics: Acidosis; Adult; Algorithms; Blood Coagulation Factors; Blood Component Transfusion; Cardiovascular Agents; Case Management; Catastrophic Illness; Combined Modality Therapy; Diagnosis, Differential; Drug Therapy, Combination; Embolism, Amniotic Fluid; Fatal Outcome; Female; Fibrinogen; Humans; Hypotension; Hysterectomy; Infant, Newborn; Male; Multiple Organ Failure; Placenta, Retained; Postpartum Hemorrhage; Pregnancy; Sperm Injections, Intracytoplasmic; Thrombelastography; Tranexamic Acid

Adverse events associated with sunitinib, such as cardiac toxicities, renal damage, and hemostatic complications, are well known. The authors report 3 cases in which patients experienced severe life-threatening complications after commencing sunitinib treatment. One patient developed heart failure with dilation of the left ventricle and decrease in the ejection fraction after one cycle of sunitinib and required treatment with an angiotensin-converting enzyme inhibitor, loop diuretics, and dobutamine. Another patient developed coronary artery stenosis after one cycle of sunitinib and was managed through percutaneous coronary intervention. Although follow-on coronary angiography revealed normal findings after 6 further cycles of sunitinib, this patient eventually expired due to multi-organ failure. The third patient had chronic renal failure before sunitinib treatment and required hemodialysis due to acute-on-chronic renal failure after commencing sunitinib treatment.

Topics: Acute Kidney Injury; Angioplasty, Balloon, Coronary; Antineoplastic Agents; Carcinoma, Renal Cell; Cardiovascular Agents; Coronary Stenosis; Fatal Outcome; Female; Heart Failure; Humans; Indoles; Kidney Neoplasms; Male; Middle Aged; Multiple Organ Failure; Protein Kinase Inhibitors; Pyrroles; Renal Dialysis; Sunitinib; Treatment Outcome

Decreased pediatric survival has been reported with long-duration (>4 weeks) continuous renal replacement therapy (CRRT), though the practice has not been well-described.. Retrospective chart review in a children's hospital of all patients treated with CRRT over 2 years (2003-4), including those who underwent long (group 1) and shorter duration (group 2) therapy.. We identified 39 patients: median age was 6 years (range: 0.3-23; 7 were infants), median PRISM III score was 16 (range: 4-35), and the most frequent primary diagnosis was a stem cell transplant (in 12 out of 39). At continuous renal replacement therapy initiation, almost all patients (38 out of 39) had multiorgan dysfunction syndrome, most (35 out of 39) were being treated with at least one inotrope or vasopressor, and median fluid overload was 18% (range: 1-43%). Survival was poor (38%). Groups 1 (n = 7) and 2 (n = 32) had similar age (p = 0.44), PRISM III score (p = 0.61), and stem cell transplant diagnosis (p = 0.65). At CRRT initiation, the incidence of multiorgan dysfunction syndrome (p=0.18), inotrope or vasopressor treatment (p = 0.56), and fluid overload severity (p = 0.71) were similar. Those in group 1 had a longer mean CRRT as well as persistent cardiovascular dysfunction limiting the utility of intermittent dialysis. Survival was similar between groups (p = 1).. Critically-ill patients treated with long and shorter duration CRRT had a similar survival rate.

Topics: Adolescent; Cardiovascular Agents; Child; Child, Preschool; Critical Illness; Female; Hemofiltration; Hospital Mortality; Humans; Infant; Male; Multiple Organ Failure; New York City; Respiration, Artificial; Retrospective Studies; Stem Cell Transplantation; Survival Rate; Time Factors; Treatment Outcome; Water-Electrolyte Imbalance; Young Adult

Topics: Acute Coronary Syndrome; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Drug-Eluting Stents; Fatal Outcome; Humans; Male; Multiple Organ Failure; Platelet Aggregation Inhibitors; Sirolimus; Thrombosis; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Interventional

The landmark Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial first demonstrated that implantation of left ventricular assist devices (LVADs) as destination therapy (DT) can provide survival superior to any known medical treatment in patients with end-stage heart failure who are ineligible for transplantation. In the present study, we describe outcomes of DT in the post-REMATCH era in the United States.. The present study included 280 patients who underwent HeartMate XVE LVAD implantation between November 2001 and December 2005. A preoperative risk score for in-hospital mortality after LVAD implantation was established in 222 patients with complete data. All patients were followed up until death or December 2006. The 1-year survival after LVAD implantation was 56%. The in-hospital mortality after LVAD surgery was 27%. The main causes of death included sepsis, right heart failure, and multiorgan failure. The most important determinants of in-hospital mortality were poor nutrition, hematological abnormalities, markers of end-organ or right ventricular dysfunction, and lack of inotropic support. Stratification of DT candidates into low (n=65), medium (n=111), high (n=28), and very high (n=18) risk on the basis of the risk score calculated from these predictors corresponded with 1-year survival rates of 81%, 62%, 28%, and 11%, respectively.. Appropriate selection of candidates and timing of LVAD implantation are critical for improved outcomes of DT. Patients with advanced heart failure who are referred for DT before major complications of heart failure develop have the best chance of achieving an excellent 1-year survival with LVAD therapy.

Topics: Aged; Cardiovascular Agents; Cause of Death; Equipment Failure; Female; Follow-Up Studies; Heart Failure; Heart Transplantation; Heart-Assist Devices; Hematologic Diseases; Hospital Mortality; Hospitalization; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Malnutrition; Middle Aged; Multiple Organ Failure; Quality of Life; Registries; Retrospective Studies; Risk; Sepsis; Survival Analysis; Survival Rate; Treatment Outcome; United States; Ventricular Dysfunction, Right