Critical Care Wizard

Surviving sepsis: going beyond the guidelines

Abstract

The Surviving Sepsis Campaign is a global effort to improve the care of patients with severe sepsis and septic shock. The first Surviving Sepsis Campaign Guidelines were published in 2004 with an updated version published in 2008. These guidelines have been endorsed by many professional organizations throughout the world and come regarded as the standard of care for the management of patients with severe sepsis. Unfortunately, most of the recommendations of these guidelines are not evidence-based. Furthermore, the major components of the 6-hour bundle are based on a single-center study whose validity has been recently under increasing scrutiny. This paper reviews the validity of the Surviving Sepsis Campaign 6-hour bundle and provides a more evidence-based approach to the initial resuscitation of patients with severe sepsis. read more...
http://www.annalsofintensivecare.com/content/1/1/17

Surviving sepsis: going beyond the guidelines The Surviving Sepsis Campaign is a global effort to improve the care of patients with severe sepsis and septic shock. The first Surviving Sepsis Campaign Guidelines were published in 2004 with an updated version published in 2008. These guidelines have been endorsed by many professional organization...

Breaking the cycle of medication overuse headache

When patients who have frequent, disabling migraines take medications to relieve their symptoms, they run the risk that the attacks will increase in frequency to daily or near-daily as a rebound effect comes into play. This pattern, called medication overuse headache, is more likely to happen with butalbital and opioids than with migraine-specific drugs, as partial responses lead to recurrence, repeat dosing, and, eventually, overuse. Breaking the cycle involves weaning the patient from the overused medications, setting up a preventive regimen, and setting strict limits on the use of medications to relieve acute symptoms. read more...
http://www.ccjm.org/content/77/4/236.full

Breaking the cycle of medication overuse headache EDUCATIONAL OBJECTIVE: Readers will recognize the risk of developing medication overuse headache with increasing use of medications to treat acute migraine

Comparison of the effects of dobutamine and milrinone on hemodynamic parameters and oxygen supply in patients undergoing cardiac surgery with low cardiac output after anesthetic induction

INTRODUCTION

Ventricular dysfunction can be seen, in different perioperative periods, in patients undergoing cardiac surgery, with the consequent inadequate oxygen supply to body tissues. After adjusting the blood volume, hemodynamic support with varying doses of inotropic drugs and/or vasodilators can contribute for hemodynamic adequacy. When the need of inotropic support in situations of low cardiac output is identified, dobutamine is one of the drugs used more often. More recently, phosphodiesterase inhibitors like milrinone have been indicated for this purpose 1.

In a study comparing the effects of milrinone and dobutamine in patients with low cardiac output after myocardial revascularization, the efficacy of both drugs was observed. However, patients who received dobutamine had a higher increase in cardiac output, heart rate, and mean arterial pressure while in the milrinone group patients had greater reduction in pulmonary wedge pressure 2. As for side effects observed in this study, dobutamine was associated with a higher number of cases of increased blood pressure and atrial fibrillation, while the incidence of sinus bradycardia was higher in patients treated with milrinone. This greater reduction in pulmonary wedge pressure related to milrinone can contribute for faster reduction in pulmonary congestion in patients with congestive heart failure 2,3. However, in other studies with patients with heart failure, significant differences in parameters related to right ventricular function, mortality, need of other vasodilator or inotropic drug, or need of mechanical circulatory support in cardiac transplantation with the isolate use of one of those two drugs were not observed 4,5. read more...
http://www.scielo.br/scielo.php?pid=S0034-70942010000300003&script=sci_arttext&tlng=en

Revista Brasileira de Anestesiologia - Comparison of the effects of dobutamine and milrinone on... Comparison of the effects of dobutamine and milrinone on hemodynamic parameters and oxygen supply in patients undergoing cardiac surgery with low cardiac output after anesthetic induction