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Adrenergic Downregulation in Critical Care: Molecular Mechanisms and Therapeutic Evidence.
Belletti, Alessandro; Landoni, Giovanni; Lomivorotov, Vladimir V; Oriani, Alessandro; Ajello, Silvia.
Afiliação
  • Belletti A; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: oriani.alessandro@hsr.it.
  • Landoni G; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
  • Lomivorotov VV; Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia; Novosibirsk State University, Novosibirsk, Russia.
  • Oriani A; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Ajello S; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
J Cardiothorac Vasc Anesth ; 34(4): 1023-1041, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31839459
ABSTRACT
Catecholamines remain the mainstay of therapy for acute cardiovascular dysfunction. However, adrenergic receptors quickly undergo desensitization and downregulation after prolonged stimulation. Moreover, prolonged exposure to high circulating catecholamines levels is associated with several adverse effects on different organ systems. Unfortunately, in critically ill patients, adrenergic downregulation translates into progressive reduction of cardiovascular response to exogenous catecholamine administration, leading to refractory shock. Accordingly, there has been a growing interest in recent years toward use of noncatecholaminergic inotropes and vasopressors. Several studies investigating a wide variety of catecholamine-sparing strategies (eg, levosimendan, vasopressin, ß-blockers, steroids, and use of mechanical circulatory support) have been published recently. Use of these agents was associated with improvement in hemodynamics and decreased catecholamine use but without a clear beneficial effect on major clinical outcomes. Accordingly, additional research is needed to define the optimal management of catecholamine-resistant shock.
Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: Agenda de Saúde Sustentável para as Américas Tema em saúde: Objetivo 7: Evidência e conhecimento em matéria de saúde Base de dados: MEDLINE Tipo de estudo: Síntese de evidências Idioma: Inglês Revista: J Cardiothorac Vasc Anesth Assunto da revista: Anestesiologia / Cardiologia Ano de publicação: 2020 Tipo de documento: Artigo

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Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: Agenda de Saúde Sustentável para as Américas Tema em saúde: Objetivo 7: Evidência e conhecimento em matéria de saúde Base de dados: MEDLINE Tipo de estudo: Síntese de evidências Idioma: Inglês Revista: J Cardiothorac Vasc Anesth Assunto da revista: Anestesiologia / Cardiologia Ano de publicação: 2020 Tipo de documento: Artigo
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