digoxin and Sepsis

Topics: Acute Kidney Injury; Airway Obstruction; Anemia, Hemolytic; Arteriovenous Fistula; Asphyxia Neonatorum; Cardiac Output; Digoxin; Ductus Arteriosus, Patent; Female; Heart Failure; Humans; Hyperthyroidism; Hypoglycemia; Infant; Infant, Newborn; Isoproterenol; Medical History Taking; Pregnancy; Pulmonary Edema; Pulmonary Valve; Sepsis; Streptococcal Infections; Tachycardia, Paroxysmal; Tricuspid Valve Insufficiency

Topics: Abortion, Septic; Acute Kidney Injury; Analgesics; Angiotensin II; Animals; Anti-Bacterial Agents; Antihypertensive Agents; Catecholamines; Digoxin; Disseminated Intravascular Coagulation; Diuretics; Dogs; Female; Hemodynamics; Humans; Hypnotics and Sedatives; Hypotension; Kidney; Kidney Concentrating Ability; Kidney Cortex Necrosis; Pregnancy; Pregnancy Complications, Infectious; Prostaglandins; Rabbits; Renal Dialysis; Renin; Sepsis; Shock, Septic; Sympathetic Nervous System; Tranquilizing Agents; Water-Electrolyte Balance

New-onset of atrial fibrillation (NOAF) in critically ill patients is the most common acute cardiac dysrhythmia, but evidence-based data regarding treatment strategies are scarce. In this retrospective monocentric study, we compared effectiveness of amiodarone versus digitalis for heart rate control in critically ill patients with new-onset of atrial fibrillation. We identified a total of 209 patients for the main analysis. Amiodarone as compared to digitalis was associated with a clinically relevant faster time to heart rate control < 110 bpm (2 h (IQR: 1 h to 6 h) versus 4 h (2 h to 12 h); p = 0.003) and longer durations of sinus rhythm during the first 24 h of treatment (6 h (IQR: 6 h to 22 h) versus 0 h (IQR: 0 h to 16 h); p < 0.001). However, more bradycardic episodes occurred in association with amiodarone than with digitalis (7.7% versus 3.4%; p = 0.019). Use of amiodarone was associated with an increase of noradrenalin infusion rate compared to digitalis (23.9% versus 12.0%; p = 0.019). Within the tertile of patients with the highest CRP measurements, amiodarone treated patients presented with a higher decrease in heart rate than digoxin treated patients. Clinical trials comparing different NOAF treatment strategies are much needed and should report on concomitant sympathetic activity and inflammatory status.

Topics: Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Critical Illness; Digitalis; Digoxin; Female; Heart Rate; Humans; Inflammation; Male; Middle Aged; Propensity Score; Retrospective Studies; Sepsis; Treatment Outcome

Atrial fibrillation (AF) with rapid ventricular response frequently complicates the management of critically ill patients with sepsis and may necessitate the initiation of medication to avoid hemodynamic compromise. However, the optimal medication to achieve rate control for AF with rapid ventricular response in sepsis is unclear.. What is the comparative effectiveness of frequently used AF medications (β-blockers, calcium channel blockers, amiodarone, and digoxin) on heart rate (HR) reduction among critically ill patients with sepsis and AF with rapid ventricular response?. We conducted a multicenter retrospective cohort study among patients with sepsis and AF with rapid ventricular response (HR > 110 beats/min). We compared the rate control effectiveness of β-blockers to calcium channel blockers, amiodarone, and digoxin using multivariate-adjusted, time-varying exposures in competing risk models (for death and addition of another AF medication), adjusting for fixed and time-varying confounders.. Among 666 included patients, 50.6% initially received amiodarone, 10.1% received a β-blocker, 33.8% received a calcium channel blocker, and 5.6% received digoxin. The adjusted hazard ratio for HR of < 110 beats/min by 1 h was 0.50 (95% CI, 0.34-0.74) for amiodarone vs β-blocker, 0.37 (95% CI, 0.18-0.77) for digoxin vs β-blocker, and 0.75 (95% CI, 0.51-1.11) for calcium channel blocker vs β-blocker. By 6 h, the adjusted hazard ratio for HR < 110 beats/min was 0.67 (95% CI, 0.47-0.97) for amiodarone vs β-blocker, 0.60 (95% CI, 0.36-1.004) for digoxin vs β-blocker, and 1.03 (95% CI, 0.71-1.49) for calcium channel blocker vs β-blocker.. In a large cohort of patients with sepsis and AF with rapid ventricular response, a β-blocker treatment strategy was associated with improved HR control at 1 h, but generally similar HR control at 6 h compared with amiodarone, calcium channel blocker, or digoxin.

Topics: Adrenergic beta-Antagonists; Aged; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Calcium Channel Blockers; Comparative Effectiveness Research; Critical Illness; Digoxin; Female; Heart Rate; Humans; Male; Middle Aged; Retrospective Studies; Sepsis; United States

To explore the impact of digoxin on hemodynamic parameters in patients with sepsis and tachycardia admitted to the intensive care unit.. Retrospective review of adult patients admitted to the medical and mixed ICU at Mayo Clinic Rochester, Minnesota from March 2008 to February 2018, initiated on digoxin within 24 h of ICU stay. Hemodynamic parameters were reviewed before digoxin administration and at 6, 12 and 24 h after. Adverse events including new onset conduction abnormalities or arrhythmias during the first 48 h after digoxin administration were reviewed by a critical care cardiologist.. Study included 180 patients. We observed significant decrease in heart rate from 124 (115-138) beats/min 1 h before digoxin to 101 (87-117) 6 h after digoxin and 94 (84-112) 12 h after (p < .01). Median systolic blood pressure increased from 100 (91-112) mm Hg 1 h before to 110 (100-122) (p < .01) and 111 (103-124) at 6 and 12 h respectively after digoxin.. Early digoxin administration in patients with sepsis and tachycardia is uncommon but associated with improvements of hemodynamic parameters. These preliminary results will help formulate future hypotheses for focused trials on utility, efficacy and safety of digoxin in sepsis.

Topics: Aged; Blood Pressure; Cardiotonic Agents; Critical Care; Digoxin; Female; Heart Rate; Hemodynamics; Humans; Intensive Care Units; Male; Middle Aged; Retrospective Studies; Sepsis; Tachycardia

Atrial fibrillation (AF) during sepsis is associated with increased morbidity and mortality, but practice patterns and outcomes associated with rate- and rhythm-targeted treatments for AF during sepsis are unclear.. This was a retrospective cohort study using enhanced billing data from approximately 20% of United States hospitals. We identified factors associated with IV AF treatments (?-blockers [BBs], calcium channel blockers [CCBs], digoxin, or amiodarone) during sepsis. We used propensity score matching and instrumental variable approaches to compare mortality between AF treatments.. Among 39,693 patients with AF during sepsis, mean age was 77 ± 11 years, 49% were women, and 76% were white. CCBs were the most commonly selected initial AF treatment during sepsis (14,202 patients [36%]), followed by BBs (11,290 [28%]), digoxin (7,937 [20%]), and amiodarone (6,264 [16%]). Initial AF treatment selection differed according to geographic location, hospital teaching status, and physician specialty. In propensity-matched analyses, BBs were associated with lower hospital mortality when compared with CCBs (n = 18,720; relative risk [RR], 0.92; 95% CI, 0.86-0.97), digoxin (n = 13,994; RR, 0.79; 95% CI, 0.75-0.85), and amiodarone (n = 5,378; RR, 0.64; 95% CI, 0.61-0.69). Instrumental variable analysis showed similar results (adjusted RR fifth quintile vs first quintile of hospital BB use rate, 0.67; 95% CI, 0.58-0.79). Results were similar among subgroups with new-onset or preexisting AF, heart failure, vasopressor-dependent shock, or hypertension.. Although CCBs were the most frequently used IV medications for AF during sepsis, BBs were associated with superior clinical outcomes in all subgroups analyzed. Our findings provide rationale for clinical trials comparing the effectiveness of AF rate- and rhythm-targeted treatments during sepsis.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Calcium Channel Blockers; Digoxin; Female; Hospitalization; Humans; Male; Middle Aged; Practice Patterns, Physicians'; Propensity Score; Retrospective Studies; Sepsis; Treatment Outcome; United States

Canrenone and spironolactone caused falsely low readings in a common assay for digoxin (AxSym MEIA) due to negative cross-reactivity. Misleading subtarget concentrations were repeatedly reported, and falsely guided drug dosing resulted in a case of digoxin intoxication.

Topics: Aged; Canrenone; Digoxin; Drug Interactions; Drug Monitoring; Enzyme Multiplied Immunoassay Technique; Fatal Outcome; Humans; Male; Medication Errors; Multiple Organ Failure; Sepsis; Spironolactone

The effects of an intravenous injection of Interleukin-13 (IL-13) after endotoxin administration on diaphragm muscle were studied using Wistar rats. Two treatment groups, a control (saline+endotoxin) group and an IL-13 (IL-13+endotoxin) group were studied. E. coli endotoxin (10 mg/kg) was injected intraperitoneally 5 minutes after saline or IL-13 (0.25 microg) injection. The force-frequency curves, twitch kinetics and fatigability were measured at 0 and 4 hours after endotoxin injection. The force-frequency curves and twitch tension in the control group were significantly lower at 4 hours than those at 0 hour due to endotoxin. On the other hand, IL-13 prevented the decrement of the force-frequency curves and twitch tension induced by endotoxin. Nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase histochemistry showed positive staining at 4 hours due to endotoxin in the control group; however, IL-13 also blocked NADPH diaphorase staining at 4 hours. Furthermore, the positive muscle fibers detected by the NADPH diaphorase staining were classified as type I (slow twitch) muscle fibers by ATPase staining. We conclude that IL-13 prevents the deterioration of contraction induced by endotoxin by inhibiting nitric oxide production in the diaphragm muscle, mainly the type I muscle fibers.

Topics: Animals; Cardenolides; Diaphragm; Digoxin; Interleukin-13; Muscle Contraction; Muscle, Skeletal; Rats; Rats, Wistar; Saponins; Sepsis

Topics: Adult; Antibodies, Monoclonal; Antidepressive Agents, Tricyclic; Antivenins; Arrhythmias, Cardiac; Binding Sites, Antibody; Colchicine; Digoxin; Female; Humans; Immunization, Passive; Immunoglobulin Fab Fragments; Immunotherapy; Lipopolysaccharides; Poisoning; Sepsis; Venoms

Topics: Child; Child, Preschool; Digoxin; Drug Evaluation; Heart Defects, Congenital; Heart Failure; Humans; Infant; Pneumonia; Sepsis; Tachycardia, Paroxysmal

Topics: Abortion, Septic; Adrenal Cortex Hormones; Bicarbonates; Blood Transfusion; Chloramphenicol; Digoxin; Escherichia coli Infections; Exchange Transfusion, Whole Blood; Female; Gentamicins; Humans; Hysterectomy; Isoproterenol; Kanamycin; Penicillins; Plasma Substitutes; Pregnancy; Puerperal Infection; Sepsis; Shock, Septic; Tetracycline

Topics: Adult; Digoxin; Dyspnea; Electrocardiography; Endocarditis, Bacterial; Endocarditis, Subacute Bacterial; Female; Humans; Hypotension; Lincomycin; Male; Nausea; Sepsis; Staphylococcal Infections; Vomiting

Topics: Abortion, Septic; Adult; Blood Pressure; Cardiac Catheterization; Cardiac Output; Central Venous Pressure; Computers; Digoxin; Female; Hemodynamics; Humans; Hypotension; Isoproterenol; Oxygen Consumption; Pregnancy; Puerperal Disorders; Regional Blood Flow; Sepsis; Shock, Septic; Vascular Resistance; Vasodilator Agents

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Baths; Blood Chemical Analysis; Blood Proteins; Body Weight; Burns; Child; Child, Preschool; Digoxin; Hexachlorophene; Humans; Infant; Infant, Newborn; Injections, Intravenous; Middle Aged; Norethandrolone; Sepsis

Topics: Brain Diseases; Chloramphenicol; Chlorothiazide; Digoxin; Diuretics; Drug Therapy; Endocarditis; Endocarditis, Bacterial; Erysipelothrix; Heart Failure; Heart Valve Diseases; Humans; Methicillin; Organomercury Compounds; Penicillin V; Penicillins; Probenecid; Sepsis