[Monitoring and treatment of patients with shock in the intensive care unit].
The controversy surrounding the use of the pulmonary artery catheter, has stimulated research into alternative methods of haemodynamic monitoring. As yet, however, no new gold standard has emerged. In the future, interest in haemodynamic monitoring is likely to focus more on tissue perfusion and metabolism instead of central circulation. Important causes of shock in the ICU, apart from acute blood loss, are sepsis and acute heart failure. Septic shock results from vasodilatation and myocardial dysfunction. Early initiation of aggressive fluid resuscitation, if necessary accompanied by vasoactive and inotropic agents, improves survival. In addition, low dose corticosteroids have a positive impact on mortality. In the treatment of patients with acute heart failure, phosphodiesterase III-inhibitors are becoming part of standard therapy in addition to beta-adrenoceptor agonists, especially in patients who take beta-blockers.
van Lieshout
E J
EJ
Academisch Medisch Centrum, afd. Intensive Care Volwassenen, Meibergdreef 9, 1105 AZ Amsterdam. e.j.vanlieshout@amc.uva.nl
Vroom
M B
MB
D015105:3',5'-Cyclic-AMP Phosphodiesterases / Q000037:antagonists & inhibitors; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use; D054684:Cyclic Nucleotide Phosphodiesterases, Type 3; D005440:Fluid Therapy; D006323:Heart Arrest / Q000150:complications / Q000628:therapy; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007362:Intensive Care Units; D008991:Monitoring, Physiologic; D010477:Perfusion; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D012769:Shock / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012772:Shock, Septic / Q000628:therapy
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D002316:Cardiotonic Agents; D002317:Cardiovascular Agents; D010726:Phosphodiesterase Inhibitors; D015105:3',5'-Cyclic-AMP Phosphodiesterases; D054684:Cyclic Nucleotide Phosphodiesterases, Type 3