RESUMEN
OBJECTIVE: The use of vasopressin as an adjunctive therapy in pulmonary hypertension associated with refractory systemic hypotension has increased. The objective of our study is to describe its effects on term infants. STUDY DESIGN: Retrospective observational study. Setting in a referral level IV neonatal intensive care unit from a middle-income region. The patients are term neonates admitted to our NICU who required vasopressin due to severe Pulmonary Hypertension and refractory hypotension during a 49-month period (December 2019 and December 2023). RESULTS: We identified 68 term infants, all in mechanical ventilation, receiving inhaled nitric oxide (iNO), and a phased protocol management for hypotension. Vasopressin was a started at a mean of 2 days with a mean duration of 80 h. Regarding hemodynamic outcome: diastolic, systolic, and median systemic pressure significantly increased during the first 4 h of treatment, as well as arterial pH and urine output. Accordingly, lactate and Vasoactive Inotropic Score (VIS) score decreased after 4 and 8 h, respectively, after vasopressin was started. Regarding oxygenation markers: oxygen requirements and mean airway pressure decreased significantly (and therefore the oxygenation index decreased in concordance) after 4 h of vasopressin. Echocardiographic indices of pulmonary hypertension progressively improved after vasopressin infusion with a significant decrease of tricuspid ingurgitation velocities and the rate of right-to- left ductal shunt through the ductus arteriosus. In the same way, left and right ventricular output increased after the initiation of vasopressin. CONCLUSION: This study showed that the use of vasopressin in neonates with persistent pulmonary hypertension was associated with a rapid and significant improvement in oxygenation and hemodynamic markers of perfusion, including blood pressure. Its effects begin early during the first hours of treatment.
Asunto(s)
Hipertensión Pulmonar , Hipotensión , Vasopresinas , Humanos , Recién Nacido , Estudios Retrospectivos , Hipotensión/tratamiento farmacológico , Hipotensión/etiología , Femenino , Masculino , Hipertensión Pulmonar/tratamiento farmacológico , Hipertensión Pulmonar/etiología , Vasopresinas/uso terapéutico , Vasopresinas/administración & dosificación , Vasoconstrictores/uso terapéutico , Vasoconstrictores/administración & dosificación , Óxido Nítrico/administración & dosificación , Respiración Artificial , Unidades de Cuidado Intensivo Neonatal , Ecocardiografía , Hemodinámica/efectos de los fármacosRESUMEN
Resumen La gestación cornual, también conocida como intersticial, es una gestación ectópica infrecuente que ocurre en 1/2500 a 1/5000 de los embarazos cuando el embrión implanta en el trayecto intramiometrial de la porción proximal de la trompa. Puede debutar como shock hipovolémico en un 25% de los casos, conllevando una mortalidad de hasta un 2,5%. Mediante ecografía se encuentra un saco gestacional excéntrico y rodeado por una fina capa de miometrio. El tratamiento, en la mayoría de los casos, es quirúrgico, y el control de la hemostasia supone todo un reto. Se presentan dos casos clínicos de mujeres con diagnóstico de gestación intersticial en quienes se realizó exéresis por laparoscopia tras inyección de vasopresina, permitiendo así controlar el sangrado. En una de las pacientes se practicaron también puntos transfixivos transitorios en la arteria uterina y el ligamento útero-ovárico.
Abstract Cornual gestation, also known as interstitial, is a rare ectopic gestation that occurs in 1/2500 to 1/5000 of pregnancies when the embryo implants in the intramyometrial tract of the proximal tube. It can debut as hypovolemic shock in 25% of cases, leading to a mortality rate of up to 2.5%. Using ultrasound, we will find an eccentric gestational sac surrounded by a thin layer of myometrium. Treatment, in most cases, is surgical and control of hemostasis is a challenge. Two clinical cases are presented of women with a diagnosis of interstitial pregnancy in whom transient transfixive sutures were performed at the level of the uterine artery and uterine-ovarian ligament and injection of vasopressin prior to laparoscopic exeresis, thus allowing the bleeding to be controlled.
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Vasopresinas/administración & dosificación , Hemostáticos/administración & dosificación , Laparoscopía/métodos , Embarazo Cornual/cirugía , Pérdida de Sangre Quirúrgica/prevención & control , Técnicas de Sutura , InyeccionesRESUMEN
Vasopressin has been used to augment blood pressure; however, cardiovascular effects after cardiac surgery have not been well established. The primary objective of this study was to survey the current literature and quantify the pooled effect of vasopressin on hemodynamic parameters in children after pediatric cardiac surgery. A systematic review was conducted to identify studies characterizing the hemodynamic effects of vasopressin after pediatric cardiac surgery. Studies were assessed and those of satisfactory quality with pre- and post-vasopressin hemodynamics for each patient were included in the final analyses. 6 studies with 160 patients were included for endpoints during the first 2 h of infusions. Patients who received vasopressin infusion had greater mean, systolic, and diastolic blood pressures and lower heart rates at 2 h after initiation. 8 studies with 338 patients were included for the effects at 24 h. Patients who received vasopressin infusion had lower central venous pressures and decreased lactate concentrations 24 h after initiation. A subset analysis for children with functionally univentricular hearts found significant decrease in inotrope score and central venous pressure. A subset analysis for neonates found significant decrease in inotrope score and fluid balance. Vasopressin leads to decrease in heart rate and increase in blood pressure in the first 2 h of initiation. Later effects include decrease in inotrope score, central venous pressure, fluid balance, and in lactate within the first 24 h. Findings vary in neonates and in those with functionally univentricular hearts although beneficial effects are noted in both.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Cardiopatías Congénitas/cirugía , Vasoconstrictores/administración & dosificación , Vasopresinas/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Preescolar , Femenino , Cardiopatías Congénitas/tratamiento farmacológico , Frecuencia Cardíaca/efectos de los fármacos , Hemodinámica/efectos de los fármacos , Humanos , Lactante , Recién Nacido , Infusiones Intravenosas , Ácido Láctico/sangre , Masculino , Cuidados Posoperatorios/métodosRESUMEN
PURPOSE: Our main objective was to use the Maximum Acute Gastrointestinal Injury Score (AGImax) to evaluate the prognostic capability of gastrointestinal dysfunction (GID), on hospital mortality in patients on mechanical ventilation (MV) requiring vasopressors. A secondary goal was to analyze the relationship between AGImax and vasopressor dosage with increasing caloric intake. MATERIALS AND METHODS: Prospective multicenter cohort study in ten ICUs across Argentina. Consecutive adult patients on MV, requiring vasopressors and receiving enteral nutrition (EN) were included. AGImax was identified (I-IV) using a modified AGI score. Comparisons of clinical and outcome variables were performed in 3 predetermined EN-groups: <10 kcal/kg/d, ≥10 to <20 kcal/kg/d, or ≥ 20 kcal/kg/d. RESULTS: A total of 494 patients met all inclusion criteria. Forty-four percent of patients had severe AGImax and 17% received <10 kcal/kg/day, indicating more severity and higher mortality. Notable independent predictors of mortality were AGImax, vasopressors, and caloric intake. PN was the only factor which had an inverse relationship to mortality. CONCLUSIONS: In this population, patients with AGImax III-IV were significantly associated with lower caloric intake and greater hospital mortality, highlighting the importance of AGI as a prognostic tool. As PN was linked with lower mortality, it could be an option to explore in further studies.
Asunto(s)
Ingestión de Energía , Tracto Gastrointestinal/lesiones , Puntaje de Gravedad del Traumatismo , Choque/terapia , Vasopresinas/uso terapéutico , Adulto , Argentina , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Respiración Artificial , Choque/mortalidad , Vasopresinas/administración & dosificaciónRESUMEN
Urinary bladder dysfunctions show high prevalence in women. We focused to investigate the intravenous and in situ (topic) vasopressin effects on the bladder and also to characterize the vasopressin receptor subtypes in the bladder. Adult female Wistar rats anesthetized with isoflurane underwent to the cannulation of the femoral artery and vein, and also urinary bladder for mean arterial pressure, heart rate and intravesical pressure (IP) recordings, respectively. Doppler flow probe was placed around the renal artery for blood flow measurement. After baseline recordings, intravenous injection of saline or vasopressin at different doses (0.25, 0.5, 1.0â¯ng/ml/kg of b.w.); or 0.1â¯ml of saline or 0.1â¯ml of vasopressin at different doses (0.25, 0.5, 1.0â¯ng/ml) was randomly dropped on the bladder. In another group of rats, the UB was harvest for gene expression by qPCR and also for protein expression by Western blotting of the vasopressin receptor subtypes. We observed that either intravenous or in situ vasopressin evoked a huge increase in the IP in a dose-dependent manner compared to saline, whilst no differences were observed in the cardiovascular parameters. The genes and the protein expression of V1a, V1b and V2 vasopressin receptors subtypes were found in the bladder. Intravenous injection of V1a or V2 receptor antagonist evoked a huge fall in IP and 30â¯min later, i.v or in situ vasopressin evoked responses on IP were significantly attenuated. Therefore, intravenous or in situ vasopressin increases the IP due to binding in V1a or V2 receptors localized in the bladder.
Asunto(s)
Receptores de Vasopresinas/metabolismo , Vejiga Urinaria/efectos de los fármacos , Vejiga Urinaria/metabolismo , Vasopresinas/administración & dosificación , Vasopresinas/farmacología , Anestesia , Animales , Presión Arterial/efectos de los fármacos , Femenino , Regulación de la Expresión Génica/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Inyecciones Intravenosas , Riñón/efectos de los fármacos , Riñón/fisiología , Ratas , Ratas Wistar , Receptores de Vasopresinas/genéticaRESUMEN
OBJECTIVES: To assess the impact of vasopressin on the microcirculation and to develop a predictive model to estimate the probability of microcirculatory recruitment in patients with septic shock. METHODS: This prospective interventional study included patients with septic shock receiving noradrenaline for less than 48 hours. We infused vasopressin at 0.04 U/min for one hour. Hemodynamic measurements, including sidestream dark-field imaging, were obtained immediately before vasopressin infusion, 1 hour after vasopressin infusion and 1 hour after vasopressin withdrawal. We defined patients with more than a 10% increase in total vascular density and perfused vascular density as responders. ClinicalTrials.gov: NCT02053675. RESULTS: Eighteen patients were included, and nine (50%) showed improved microcirculation after infusion of vasopressin. The noradrenaline dose was significantly reduced after vasopressin (p=0.001) and was higher both at baseline and during vasopressin infusion in the responders than in the non-responders. The strongest predictor for a favorable microcirculatory response was the dose of noradrenaline at baseline (OR=4.5; 95% CI: 1.2-17.0; p=0.027). For patients using a noradrenaline dose higher than 0.38 mcg/kg/min, the probability that microcirculatory perfusion would be improved with vasopressin was 53% (sensitivity 78%, specificity 77%). CONCLUSIONS: In patients with septic shock for no longer than 48 h, administration of vasopressin is likely to result in an improvement in microcirculation when the baseline noradrenaline dose is higher than 0.38 mcg/kg/min.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Choque Séptico/tratamiento farmacológico , Vasoconstrictores/administración & dosificación , Vasopresinas/administración & dosificación , Norepinefrina/administración & dosificación , Microcirculación/efectos de los fármacos , Choque Séptico/fisiopatología , Vasoconstrictores/farmacología , Vasopresinas/farmacología , Norepinefrina/farmacología , Estudios Prospectivos , Quimioterapia CombinadaRESUMEN
OBJECTIVES: To assess the impact of vasopressin on the microcirculation and to develop a predictive model to estimate the probability of microcirculatory recruitment in patients with septic shock. METHODS: This prospective interventional study included patients with septic shock receiving noradrenaline for less than 48 hours. We infused vasopressin at 0.04 U/min for one hour. Hemodynamic measurements, including sidestream dark-field imaging, were obtained immediately before vasopressin infusion, 1 hour after vasopressin infusion and 1 hour after vasopressin withdrawal. We defined patients with more than a 10% increase in total vascular density and perfused vascular density as responders. ClinicalTrials.gov: NCT02053675. RESULTS: Eighteen patients were included, and nine (50%) showed improved microcirculation after infusion of vasopressin. The noradrenaline dose was significantly reduced after vasopressin (p=0.001) and was higher both at baseline and during vasopressin infusion in the responders than in the non-responders. The strongest predictor for a favorable microcirculatory response was the dose of noradrenaline at baseline (OR=4.5; 95% CI: 1.2-17.0; p=0.027). For patients using a noradrenaline dose higher than 0.38 mcg/kg/min, the probability that microcirculatory perfusion would be improved with vasopressin was 53% (sensitivity 78%, specificity 77%). CONCLUSIONS: In patients with septic shock for no longer than 48 h, administration of vasopressin is likely to result in an improvement in microcirculation when the baseline noradrenaline dose is higher than 0.38 mcg/kg/min.
Asunto(s)
Microcirculación/efectos de los fármacos , Norepinefrina/administración & dosificación , Choque Séptico/tratamiento farmacológico , Vasoconstrictores/administración & dosificación , Vasopresinas/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Norepinefrina/farmacología , Estudios Prospectivos , Choque Séptico/fisiopatología , Vasoconstrictores/farmacología , Vasopresinas/farmacologíaAsunto(s)
Presión Sanguínea/efectos de los fármacos , Dopamina/administración & dosificación , Hipotensión/tratamiento farmacológico , Recien Nacido con Peso al Nacer Extremadamente Bajo , Enfermedades del Prematuro/tratamiento farmacológico , Recien Nacido Prematuro , Vasopresinas/administración & dosificación , Femenino , Humanos , MasculinoAsunto(s)
Presión Sanguínea/efectos de los fármacos , Dopamina/administración & dosificación , Hipotensión/tratamiento farmacológico , Recien Nacido con Peso al Nacer Extremadamente Bajo , Enfermedades del Prematuro/tratamiento farmacológico , Recien Nacido Prematuro , Vasopresinas/administración & dosificación , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVE: To evaluate vasopressin vs dopamine as initial therapy in extremely low birth weight (ELBW) infants with hypotension during the first 24 hours of life. STUDY DESIGN: ELBW infants with hypertension ≤ 30 weeks' gestation and ≤ 24 hours old randomly received treatment with vasopressin or dopamine in a blinded fashion. Normotensive infants not receiving vasopressor support served as a comparison group. RESULTS: Twenty ELBW infants with hypertension received vasopressin (n = 10) or dopamine (n = 10), and 50 were enrolled for comparison. Mean gestational age was 25.6 ± 1.4 weeks and birth weight 705 ± 154 g. Response to vasopressin paralleled that of dopamine in time to adequate mean blood pressure (Kaplan-Meier curve, P = .986); 90% of infants in each treatment group responded with adequate blood pressure. The vasopressin group received fewer doses of surfactant (P < .05), had lower PaCO2 values (P < .05), and were not tachycardic (P < .001) during vasopressin administration, compared with the dopamine group. CONCLUSIONS: Vasopressin in ELBW infants as the initial agent for early hypotension appeared safe. This pilot study supports a larger randomized controlled trial of vasopressin vs dopamine therapy in ELBW infants with hypotension.
Asunto(s)
Presión Sanguínea/efectos de los fármacos , Dopamina/administración & dosificación , Hipotensión/tratamiento farmacológico , Recien Nacido con Peso al Nacer Extremadamente Bajo , Enfermedades del Prematuro/tratamiento farmacológico , Recien Nacido Prematuro , Vasopresinas/administración & dosificación , Cardiotónicos , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Hipotensión/fisiopatología , Recién Nacido , Enfermedades del Prematuro/fisiopatología , Infusiones Intravenosas , Masculino , Proyectos Piloto , Estudios Prospectivos , Resultado del Tratamiento , Vasoconstrictores/administración & dosificaciónRESUMEN
The Advanced Cardiac Life Support proposes the use of vasopressor drugs cardiopulmonary resuscitation, with the primary purpose of effectively and early restoration of spontaneous circulation. However, the increased return of spontaneous circulation with vasopressors has not improved neurological outcome at hospital discharge. Adrenaline has traditionally been the main tool of the cardiopulmonary resuscitation guidelines despite the lack of conclusive scientific evidence. Therefore other alternatives were considered at experimental level that has have failed to overcome the clinical results of this drug. In contrast to progress on the standardized management of cardiopulmonary resuscitation, the controversy regarding the effectiveness of vasopressor therapy remains open in the last years due to lack of clinical data to support their usefulness.
El soporte vital avanzado propone el uso de vasopresores durante la resucitación cardiopulmonar, con la finalidad primordial de reestablecer de manera precoz y efectiva la circulación espontánea. Sin embargo, el aumento del retorno a la circulación espontánea asociada a los vasopresores no ha demostrado una mejoría en el pronóstico neurológico al alta hospitalaria. La adrenalina, ha sido tradicionalmente la herramienta principal de las guías de resucitación cardiopulmonar pese a la falta de evidencia científica concluyente. Por ello se han planteado otras alternativas a nivel experimental que no han logrado superar los resultados de este fármaco a nivel clínico. En contraste con los avances respecto al manejo estandarizado de la resucitación cardiopulmonar, el debate con respecto a la efectividad de la terapia vasopresora se mantiene abierto en los últimos años dada la falta de datos clínicos que corroboren su real utilidad.
Asunto(s)
Humanos , Epinefrina/administración & dosificación , Paro Cardíaco/tratamiento farmacológico , Reanimación Cardiopulmonar/métodos , Vasoconstrictores/administración & dosificación , Vasopresinas/administración & dosificación , Apoyo Vital Cardíaco AvanzadoRESUMEN
FUNDAMENTO: Na ressuscitação cardiopulmonar (RCP) prolongada, o efeito dos vasoconstritores não foi plenamente esclarecido. OBJETIVOS: Avaliar o efeito pressórico da adrenalina e da vasopressina, e observar o retorno da circulação espontânea (RCE). MÉTODOS: Estudo prospectivo, randomizado, cego e placebo-controlado. Após sete minutos em fibrilação ventricular, porcos receberam ciclos de dois minutos de RCP. Tentou-se a desfibrilação (4 J/kg) uma vez aos 9 minutos e após cada ciclo, conforme o ritmo verificado, reiniciando-se a RCP imediatamente. Aos 9 minutos e depois de cada cinco minutos, aplicou-se adrenalina 0,02 mg/kg (n = 12 porcos), ou vasopressina 0,4 U/kg (n = 12), ou solução salina 0,9% 0,2 mL/kg (n = 8). A RCP continuou por 30 minutos ou até o RCE. RESULTADOS: A pressão de perfusão coronária aumentou para aproximadamente 20 mmHg nos três grupos. Com os vasoconstritores, a pressão alcançou 35 mmHg versus 15 mmHg com placebo (p < 0,001). Com vasopressina, manteve-se efeito de 15-20 mmHg após três doses versus zero com adrenalina ou placebo. Observou-se o RCE com frequência diferente (p = 0,031) entre adrenalina (10/12), vasopressina (6/12) e placebo (2/8). O tempo médio até o RCE não diferiu (16 minutos), nem o número de doses recebidas até então (uma ou duas). Entre os vasoconstritores não houve diferença significante, mas, frente ao placebo, apenas a adrenalina aumentou significantemente o RCE (p = 0,019). CONCLUSÃO: O efeito pressórico inicial dos vasoconstritores foi equivalente, e a vasopressina manteve um efeito tardio na ressuscitação prolongada. Apesar disso, comparando-se ao placebo, apenas a adrenalina aumentou significantemente a frequência do retorno da circulação espontânea.
BACKGROUND: The effect of vasoconstrictors in prolonged cardiopulmonary resuscitation (CPR) has not been fully clarified. OBJECTIVES: To evaluate adrenaline and vasopressin pressure effect, and observe the return of spontaneous circulation (ROSC). METHODS: A prospective, randomized, blinded, and placebo-controlled study. After seven minutes of untreated ventricular fibrillation, pigs received two minutes cycles of CPR. Defibrillation was attempted (4 J/kg) once at 9 minutes, and after every cycle if a shockable rhythm was present, after what CPR was immediately resumed. At 9 minutes and every five minutes intervals, 0.02 mg/kg (n = 12 pigs) adrenaline, or 0.4 U/kg (n = 12) vasopressin, or 0.2 mL/kg (n = 8) 0.9% saline solution was administered. CPR continued for 30 minutes or until the ROSC. RESULTS: Coronary perfusion pressure increased to about 20 mmHg in the three groups. Following vasoconstrictors doses, pressure level reached 35 mmHg versus 15 mmHg with placebo (p < 0.001). Vasopressin effect remained at 15-20 mmHg after three doses versus zero with adrenaline or placebo. ROSC rate differed (p = 0.031) among adrenaline (10/12), vasopressin (6/12), and placebo (2/8). Time-to-ROSC did not differ (16 minutes), nor the number of doses previously received (one or two). There was no difference between vasoconstrictors, but against placebo, only adrenaline significantly increased the ROSC rate (p = 0.019). CONCLUSION: The vasoconstrictors initial pressure effect was equivalent and vasopressin maintained a late effect at prolonged resuscitation. Nevertheless, when compared with placebo, only adrenaline significantly increased the ROSC rate.
Asunto(s)
Animales , Reanimación Cardiopulmonar , Epinefrina/administración & dosificación , Paro Cardíaco/tratamiento farmacológico , Vasoconstrictores/administración & dosificación , Vasopresinas/administración & dosificación , Fibrilación Ventricular/tratamiento farmacológico , Modelos Animales de Enfermedad , Método Doble Ciego , Evaluación Preclínica de Medicamentos , Estudios Prospectivos , Distribución Aleatoria , PorcinosRESUMEN
BACKGROUND: The effect of vasoconstrictors in prolonged cardiopulmonary resuscitation (CPR) has not been fully clarified. OBJECTIVES: To evaluate adrenaline and vasopressin pressure effect, and observe the return of spontaneous circulation (ROSC). METHODS: A prospective, randomized, blinded, and placebo-controlled study. After seven minutes of untreated ventricular fibrillation, pigs received two minutes cycles of CPR. Defibrillation was attempted (4 J/kg) once at 9 minutes, and after every cycle if a shockable rhythm was present, after what CPR was immediately resumed. At 9 minutes and every five minutes intervals, 0.02 mg/kg (n = 12 pigs) adrenaline, or 0.4 U/kg (n = 12) vasopressin, or 0.2 mL/kg (n = 8) 0.9% saline solution was administered. CPR continued for 30 minutes or until the ROSC. RESULTS: Coronary perfusion pressure increased to about 20 mmHg in the three groups. Following vasoconstrictors doses, pressure level reached 35 mmHg versus 15 mmHg with placebo (p < 0.001). Vasopressin effect remained at 15-20 mmHg after three doses versus zero with adrenaline or placebo. ROSC rate differed (p = 0.031) among adrenaline (10/12), vasopressin (6/12), and placebo (2/8). Time-to-ROSC did not differ (16 minutes), nor the number of doses previously received (one or two). There was no difference between vasoconstrictors, but against placebo, only adrenaline significantly increased the ROSC rate (p = 0.019). CONCLUSION: The vasoconstrictors initial pressure effect was equivalent and vasopressin maintained a late effect at prolonged resuscitation. Nevertheless, when compared with placebo, only adrenaline significantly increased the ROSC rate.
Asunto(s)
Reanimación Cardiopulmonar , Epinefrina/administración & dosificación , Paro Cardíaco/tratamiento farmacológico , Vasoconstrictores/administración & dosificación , Vasopresinas/administración & dosificación , Fibrilación Ventricular/tratamiento farmacológico , Animales , Modelos Animales de Enfermedad , Método Doble Ciego , Evaluación Preclínica de Medicamentos , Estudios Prospectivos , Distribución Aleatoria , PorcinosRESUMEN
Antecedentes: Descripción de la condición de salud de interés: La hipertensión portal, es comúnmente causada por la cirrosis hepática, resulta en varios flujos venosos colaterales por los cuales la sangre del sistema porta alcanza la circulación sistémica. De éstos flujos colaterales los que son clínicamente significativos son aquellos que circundan el cardias, donde la vena gástrica izquierda, la vena gástrica posterior y las venas gástricas cortas eventualmente se anastomosan con la vena ácigos menor y con la vena intercostal del sistema venoso sistémico. Esto lleva a la formación de alteraciones en la capa submucosa del tercio inferior del esófago y del fondo del estómago, y se denominan comúnmente várices. La importancia clínica radica en que la ruptura de estas várices resulta en una hemorragia gastroesofágica que es la complicación letal más frecuente de la cirrosis. Descripción de la tecnología: La somatostatina es una hormona del grupo de las hormonas hipofisiarias. La siguiente es la descripción del grupo H "Hormonas sistémicas excluyendo las hormonas sexuales y las insulinas" al cual pertenece. Evaluación de efectividad y seguridad: Pregunta de investigación: La pregunta de investigación fue validada teniendo en cuenta las siguientes fuentes de información: registro sanitario INVIMA, Acuerdo 029 de 2011, guías de práctica clínica, reportes de evaluación de tecnologías, revisiones sistemáticas y narrativas de la literatura, estudios de prevalencia/incidencia y carga de enfermedad, consulta con expertos temáticos, y otros actores clave. \r\nNo se identificaron otros comparadores relevantes para la evaluación. Población: Adultos con hemorragia de vías digestivas altas secundaria a várices esofágicas. Metodología: Búsqueda de literatura, Búsque\r\nda en bases de datos electrónicas. Conclusiones: -Efectividad: somatostatina, octreotide y terlipresina\r\nson efectivas para el tratamiento de pacientes adultos con hemorragia de vías digestivas altas secundaria a várices esofágicas. No hay diferencias estadísticamente significativas entre ellas al evaluar mortalidad, control \r\ndel sangrado y resangrado; -Seguridad: En el estudio incluido no se encontraron datos acerca de la ocurrencia de eventos adversos entre somatostatina y sus comparadores.
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Humanos , Várices Esofágicas y Gástricas/tratamiento farmacológico , Sistema Digestivo/irrigación sanguínea , Evaluación de la Tecnología Biomédica , Somatostatina/administración & dosificación , Vasopresinas/administración & dosificación , Octreótido/administración & dosificación , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare the efficacy of rectal misoprostol plus perivascular vasopressin with perivascular vasopressin alone as hemostatic agents for the reduction of blood loss during myomectomies. DESIGN: Prospective, randomized, double-blind, controlled study. SETTING: University of the West Indies and Andrews Memorial Hospital. PATIENT(S): Fifty women with symptomatic uterine fibroids, 25 receiving misoprostol and vasopressin and 25 receiving vasopressin alone before myomectomy. INTERVENTION(S): Abdominal myomectomies on patients with symptomatic uterine fibroids. MAIN OUTCOME MEASURE(S): Perioperative blood loss and febrile morbidity. RESULT(S): There were no statistically significant differences in sociodemographic, clinical, or myoma characteristics between the two groups at baseline. Postoperatively, there were no statistically significant differences in perioperative febrile morbidity or blood pressure between the groups. However, the group treated with misoprostol plus vasopressin had statistically significantly lower blood loss (geometric mean with 95% confidence interval, 334 mL [261 to 428] vs. 623 mL [354 to 1,094], a smaller change in hemoglobin (1.6 ± 1.5 vs. 3.0 ± 2.0), and a lower requirement for transfusion. In addition to treatment, significant determinants of blood loss were larger size of fibroids and greater number of fibroids. CONCLUSION(S): We conclude that perivascular vasopressin plus misoprostol caused a significant reduction in blood loss compared with perivascular vasopressin alone. CLINICAL TRIAL REGISTRATION NUMBER: NCT01700478.
Asunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Técnicas Hemostáticas , Hemostáticos/administración & dosificación , Leiomioma/cirugía , Misoprostol/administración & dosificación , Miomectomía Uterina/efectos adversos , Neoplasias Uterinas/cirugía , Vasopresinas/administración & dosificación , Administración Rectal , Adulto , Transfusión Sanguínea , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Jamaica , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Arginine vasopressin (AVP) has been broadly used in the management of vasodilatory shock. However, there are many concerns regarding its clinical use, especially in high doses, as it can be associated with adverse cardiovascular events. OBJECTIVE: To investigate the cardiovascular effects of AVP in continuous IV infusion on hemodynamic parameters in dogs. METHODS: Sixteen healthy mongrel dogs, anesthetized with pentobarbital were intravascularly catheterized, and randomly assigned to: control (saline-placebo; n=8) and AVP (n=8) groups. The study group was infused with AVP for three consecutive 10-minute periods at logarithmically increasing doses (0.01; 0.1 and 1.0 U/kg/min), at them 20-min intervals. Heart rate (HR) and intravascular pressures were continuously recorded. Cardiac output was measured by the thermodilution method. RESULTS: No significant hemodynamic effects were observed during 0.01 U/kg/min of AVP infusion, but at higher doses (0.1 and 1.0 U/kg/min) a progressive increase in mean arterial pressure (MAP) and systemic vascular resistance index (SVRI) were observed, with a significant decrease in HR and the cardiac index (CI). A significant increase in the pulmonary vascular resistance index (PVRI) was also observed with the 1.0 U/kg/min dose, mainly due to the decrease in the CI. CONCLUSION: AVP, when administered at doses between 0.1 and 1.0 U/kg/min, induced significant increases in MAP and SVRI, with negative inotropic and chronotropic effects in healthy animals. Although these doses are ten to thousand times greater than those routinely used for the management of vasodilatory shock, our data confirm that AVP might be used carefully and under strict hemodynamic monitoring in clinical practice, especially if doses higher than 0.01 U/kg/min are needed.
Asunto(s)
Sistema Cardiovascular/efectos de los fármacos , Vasoconstrictores/administración & dosificación , Vasopresinas/administración & dosificación , Análisis de Varianza , Anestesia , Animales , Perros , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Hemodinámica/efectos de los fármacos , Infusiones Intravenosas , Masculino , Modelos Animales , Distribución Aleatoria , Resistencia Vascular/efectos de los fármacos , Resistencia Vascular/fisiología , Vasoconstrictores/efectos adversos , Vasopresinas/efectos adversosRESUMEN
FUNDAMENTO: A arginina-vasopressina (AVP) tem sido amplamente utilizada no tratamento do choque vasodilatador. Entretanto, há muitas questões relativas ao seu uso clínico, especialmente em altas doses, pois sua utilização pode estar associada a efeitos cardíacos adversos. OBJETIVO: Investigar os efeitos cardiovasculares da AVP em infusão IV contínua nos parâmetros hemodinâmicos em cães. MÉTODOS: Dezesseis cães saudáveis sem raça definida, anestesiados com pentobarbital, receberam um cateter intravascular e foram aleatoriamente designados para dois grupos: controle (solução salina - placebo; n=8) e AVP (n=8). O grupo do estudo recebeu infusão de AVP por três períodos consecutivos de 10 minutos a doses logaritmicamente progressivas (0,01; 0,1 e 1,0 U/kg/min), a intervalos de 20 minutos. A frequência cardíaca (HR) e as pressões intravasculares foram continuamente registradas. O debito cardíaco foi medido através do método de termodiluição. RESULTADOS: Nenhum efeito hemodinâmico significante foi observado durante a infusão de 0,01 U/kg/min de AVP, mas com as doses mais altas, de 0,1 e 1,0U/kg/min, houve um aumento progressivo na pressão arterial média (PAM) e índice de resistência vascular sistêmica (IRVS), com significante diminuição na frequência cardíaca (FC) e índice cardíaco (IC). Com a dose de 1,0 U/kg/min, também foi observado um aumento significante no índice de resistência vascular pulmonar (IRVP), principalmente devido à diminuição no IC. CONCLUSÃO: A AVP em doses entre 0,1 e 1,0 U/kg/min resultou em significantes aumentos na PAM e no IRVS, com efeitos inotrópicos e cronotrópicos negativos em animais saudáveis. Embora essas doses sejam de 10 a 1.000 vezes maiores do que as rotineiramente utilizadas no tratamento do choque vasodilatador, nossos dados confirmam que a AVP deveria ser usada cuidadosamente e sob rígida monitoração hemodinâmica na prática clínica, especialmente se doses maiores do que 0,01 U/kg/min forem necessárias.
BACKGROUND: Arginine vasopressin (AVP) has been broadly used in the management of vasodilatory shock. However, there are many concerns regarding its clinical use, especially in high doses, as it can be associated with adverse cardiovascular events. OBJECTIVE: To investigate the cardiovascular effects of AVP in continuous IV infusion on hemodynamic parameters in dogs. METHODS: Sixteen healthy mongrel dogs, anesthetized with pentobarbital were intravascularly catheterized, and randomly assigned to: control (saline-placebo; n=8) and AVP (n=8) groups. The study group was infused with AVP for three consecutive 10-minute periods at logarithmically increasing doses (0.01; 0.1 and 1.0U/kg/min), at them 20-min intervals. Heart rate (HR) and intravascular pressures were continuously recorded. Cardiac output was measured by the thermodilution method. RESULTS: No significant hemodynamic effects were observed during 0.01U/kg/min of AVP infusion, but at higher doses (0.1 and 1.0U/kg/min) a progressive increase in mean arterial pressure (MAP) and systemic vascular resistance index (SVRI) were observed, with a significant decrease in HR and the cardiac index (CI). A significant increase in the pulmonary vascular resistance index (PVRI) was also observed with the 1.0U/kg/min dose, mainly due to the decrease in the CI. CONCLUSION: AVP, when administered at doses between 0.1 and 1.0U/kg/min, induced significant increases in MAP and SVRI, with negative inotropic and chronotropic effects in healthy animals. Although these doses are ten to thousand times greater than those routinely used for the management of vasodilatory shock, our data confirm that AVP might be used carefully and under strict hemodynamic monitoring in clinical practice, especially if doses higher than 0.01 U/kg/min are needed.
FUNDAMENTO: La arginina-vasopresina (AVP) ha sido ampliamente utilizada en el tratamiento del choque vasodilatador. No obstante, hay muchos aspectos relativos a su uso clínico, especialmente en altas dosis, pues su utilización puede estar asociada a efectos cardíacos adversos. OBJETIVO: Investigar los efectos cardiovasculares de la AVP en infusión IV continua en los parámetros hemodinámicos en canes. MÉTODOS: Dieciséis canes saludables sin raza definida, anestesiados con pentobarbital, recibieron un catéter intravascular y fueron aleatoriamente designados para dos grupos: control (solución salina - placebo; n=8) y AVP (n=8). El grupo del estudio recibió infusión de AVP por tres períodos consecutivos de 10 minutos a dosis logarítimicamente progresivas (0,01; 0,1 y 1,0 U/kg/min), a intervalos de 20 minutos La frecuencia cardíaca (HR) y las presiones intravasculares fueron registradas continuamente. El débito cardíaco fue medido a través del método de termodilución. RESULTADOS: No se observó ningún efecto hemodinámico significativo durante la infusión de 0,01 U/kg/min de AVP, pero con las dosis más altas, de 0,1 y 1,0 U/kg/min, hubo un aumento progresivo en la presión arterial media (PAM) y en el índice de resistencia vascular sistémica (IRVS), con significativa disminución en la frecuencia cardíaca (FC) e índice cardíaco (IC). Con la dosis 1,0 U/kg/min, también se observó un aumento significativo en el índice de resistencia vascular pulmonar (IRVP), principalmente debido a la disminución en el IC. CONCLUSIÓN: La AVP en dosis entre 0,1 y 1,0 U/kg/min resultó en significativos aumentos en la PAM y en el IRVS, con efectos inotrópicos y cronotrópicos negativos en animales saludables. Aunque estas dosis sean de 10 a 1.000 veces mayores que las rutinariamente utilizadas en el tratamiento del choque vasodilatador, nuestros datos confirman que la AVP debería ser usada cuidadosamente y bajo rígido monitoreo hemodinámico en la práctica clínica, especialmente ...
Asunto(s)
Animales , Perros , Femenino , Masculino , Sistema Cardiovascular/efectos de los fármacos , Vasoconstrictores/administración & dosificación , Vasopresinas/administración & dosificación , Análisis de Varianza , Anestesia , Frecuencia Cardíaca/efectos de los fármacos , Hemodinámica/efectos de los fármacos , Infusiones Intravenosas , Modelos Animales , Distribución Aleatoria , Resistencia Vascular/efectos de los fármacos , Resistencia Vascular/fisiología , Vasoconstrictores/efectos adversos , Vasopresinas/efectos adversosRESUMEN
Biosurgical compounds and pharmacologic agents can serve as surgical adjuncts to prevent or curtail intraoperative bleeding. Medline, PubMed, and Cochrane electronic data bases were used to search the English literature from 1966 to March 2007 using the terms topical, hemostatic agents, and gynecologic surgery. Several effective topical hemostatic agents are available to reduce intraoperative blood loss. Data on their application in gynecologic surgery are limited, and guidelines for selecting one over another for specific indications are lacking.
Asunto(s)
Hemostasis Quirúrgica , Hemostáticos/farmacología , Celulosa Oxidada/farmacología , Fibrina/administración & dosificación , Gelatina/administración & dosificación , Procedimientos Quirúrgicos Ginecológicos , Hemostáticos/administración & dosificación , Humanos , Trombina/farmacología , Vasopresinas/administración & dosificación , Vasopresinas/farmacologíaAsunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Hemostáticos/administración & dosificación , Histerectomía Vaginal , Vasopresinas/administración & dosificación , Femenino , Humanos , Histerectomía Vaginal/métodos , Persona de Mediana Edad , Estudios Retrospectivos , Cloruro de Sodio/administración & dosificaciónRESUMEN
In this study we investigated the influence of d(CH2)5-Tyr(Me)-[Arg8]vasopressin (AAVP) and [adamanteanacetyl1,0-ET-d-Tyr2,Val4,aminobutyryl6,Arg8,9]-[Arg8]vasopressin (ATAVP), which are antagonists of vasopressin V1 and V2 receptors, and the effects of losartan, a selective angiotensin AT1 receptor antagonist, and CGP42112A, a selective AT2 receptor antagonist, injected into the lateral septal area (LSA) on thirst and hypertension induced by [Arg8]vasopressin (AVP). AAVP and ATAVP injected into the LSA reduced the drinking responses elicited by injecting AVP into the LSA. Both the AT1 and AT2 ligands administered into the LSA elicited a concentration-dependent decrease in the water intake induced by AVP injected into the LSA, but losartan was more effective than CGP42112A. The increase in MAP, due to injection of AVP into the LSA, was reduced by prior injection of AAVP from 18 +/- 1 to 6 +/- 1 mm Hg. Losartan injected into the LSA prior to AVP reduced the increase in MAP to 7 +/- 0.8 mm Hg. ATAVP and CGP42112A produced no changes in the pressor effect of AVP. These results suggest that the dipsogenic effects induced by injecting AVP into the LSA were mediated primarily by AT1 receptors. However, doses of losartan were more effective when combined with CGP42112A than when given alone, suggesting that the thirst induced by AVP injections into LSA may involve activation of multiple AVP and angiotensin II receptor subtypes. The pressor response of AVP was reduced by losartan and by AAVP. CGP42112A and ATAVP did not change the AVP pressor response. These results suggest that facilitator effects of AVP on water intake are mediated through the activation of V1 receptors and that the inhibitory effect requires V2 receptors. The involvement of AT1 and AT2 receptors can be postulated. Based on the present findings, we suggest that the AVP in the LSA may play a role in the control of water and arterial blood pressure balance.