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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.
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).
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]
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]
Vasopressin (antidiuretic hormone, ADH) is another vasopressor often used in combination with norepinephrine [10] Certain vasopressors ( ephedrine , norepinephrine ). Norepinephrine (Levophed) is the most common first-line vasopressor for people who don't respond well to other hypotension treatments such as fluid resuscitation.
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]
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 ]
Opening and keeping open the microcirculation is a consideration in the treatment of distributive shock, as a result limiting the use of vasopressors has been suggested. [2] Control of inflammation, vascular function and coagulation to correct pathological differences in blood flow and microvascular shunting has been pointed to as a potentially ...