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Intensive care unit ICU patients often require mechanical ventilation if they have lost the ability to breathe normally.. An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive care medicine.
The SOFA scoring system is useful in predicting the clinical outcomes of critically ill patients. [8] According to an observational study at an Intensive Care Unit (ICU) in Belgium, the mortality rate is at least 50% when the score is increased, regardless of initial score, in the first 96 hours of admission, 27% to 35% if the score remains unchanged, and less than 27% if the score is reduced. [9]
An antihypotensive, also known as vasopressor, is an agent that raises blood pressure by constricting blood vessels, thereby increasing systemic vascular resistance. This is different from inotropes which increase the force of cardiac contraction. Some substances do both (e.g. dopamine, dobutamine).
This score can help medical providers determine a patient's need for admission to an intensive care unit (ICU) or further intensive respiratory support or vasopressor medications. Further support or admission to the ICU should be considered in patients <50 years old with a Horowitz index <333 mmHg or >50 years old with Horowitz index <250 mmHg. [8]
Among the choices for vasopressors, norepinephrine is superior to dopamine in septic shock. [17] Norepinephrine is the preferred vasopressor, while epinephrine may be added to norepinephrine when needed. Low-dose vasopressin also may be used as an addition to norepinephrine, but is not recommended as a first-line treatment.
Cushing reflex (also referred to as the vasopressor response, the Cushing effect, the Cushing reaction, the Cushing phenomenon, the Cushing response, or Cushing's Law) is a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing's triad of increased blood pressure, irregular breathing, and bradycardia. [1]
The definition of refractory shock or vasodilatory shock varies. In 2018, the American College of Chest Physician stated that it is presents if there is an inadequate response to high-dose vasopressor therapy defined as ≥ 0.5 mg/kg/min norepinephrine-equivalent dose. [4]
Vasopressors have not been found to improve outcomes when used for hemorrhagic shock from trauma [38] but may be of use in neurogenic shock. [20] Activated protein C (Xigris), while once aggressively promoted for the management of septic shock , has been found not to improve survival and is associated with a number of complications. [ 39 ]