LUDHMILA ABRAHAO HAJJAR

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Departamento de Clínica Médica, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 34 Citação(ões) na Scopus
    Current use of inotropes in circulatory shock
    (2021) SCHEEREN, Thomas W. L.; BAKKER, Jan; KAUFMANN, Thomas; ANNANE, Djillali; ASFAR, Pierre; BOERMA, E. Christiaan; CECCONI, Maurizio; CHEW, Michelle S.; CHOLLEY, Bernard; CRONHJORT, Maria; BACKER, Daniel De; DUBIN, Arnaldo; DUENSER, Martin W.; DURANTEAU, Jacques; GORDON, Anthony C.; HAJJAR, Ludhmila A.; HAMZAOUI, Olfa; HERNANDEZ, Glenn; EDUL, Vanina Kanoore; KOSTER, Geert; LANDONI, Giovanni; LEONE, Marc; LEVY, Bruno; MARTIN, Claude; MEBAZAA, Alexandre; MONNET, Xavier; MORELLI, Andrea; PAYEN, Didier; PEARSE, Rupert M.; PINSKY, Michael R.; RADERMACHER, Peter; REUTER, Daniel A.; SAKR, Yasser; SANDER, Michael; SAUGEL, Bernd; SINGER, Mervyn; SQUARA, Pierre; VIEILLARD-BARON, Antoine; VIGNON, Philippe; VINCENT, Jean-Louis; HORST, Iwan C. C. van der; VISTISEN, Simon T.; TEBOUL, Jean-Louis
    Background: Treatment decisions on critically ill patients with circulatory shock lack consensus. In an international survey, we aimed to evaluate the indications, current practice, and therapeutic goals of inotrope therapy in the treatment of patients with circulatory shock. Methods: From November 2016 to April 2017, an anonymous web-based survey on the use of cardiovascular drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 14 questions focused on the profile of respondents, the triggering factors, first-line choice, dosing, timing, targets, additional treatment strategy, and suggested effect of inotropes. In addition, a group of 42 international ESICM experts was asked to formulate recommendations for the use of inotropes based on 11 questions. Results: A total of 839 physicians from 82 countries responded. Dobutamine was the first-line inotrope in critically ill patients with acute heart failure for 84% of respondents. Two-thirds of respondents (66%) stated to use inotropes when there were persistent clinical signs of hypoperfusion or persistent hyperlactatemia despite a supposed adequate use of fluids and vasopressors, with (44%) or without (22%) the context of low left ventricular ejection fraction. Nearly half (44%) of respondents stated an adequate cardiac output as target for inotropic treatment. The experts agreed on 11 strong recommendations, all of which were based on excellent (> 90%) or good (81-90%) agreement. Recommendations include the indications for inotropes (septic and cardiogenic shock), the choice of drugs (dobutamine, not dopamine), the triggers (low cardiac output and clinical signs of hypoperfusion) and targets (adequate cardiac output) and stopping criteria (adverse effects and clinical improvement). Conclusion: Inotrope use in critically ill patients is quite heterogeneous as self-reported by individual caregivers. Eleven strong recommendations on the indications, choice, triggers and targets for the use of inotropes are given by international experts. Future studies should focus on consistent indications for inotrope use and implementation into a guideline for circulatory shock that encompasses individualized targets and outcomes.
  • article 8 Citação(ões) na Scopus
    Effect of postoperative goal-directed therapy in cancer patients undergoing high-risk surgery: a randomized clinical trial and meta-analysis
    (2018) GERENT, Aline Rejane Muller; ALMEIDA, Juliano Pinheiro; FOMINSKIY, Evgeny; LANDONI, Giovanni; OLIVEIRA, Gisele Queiroz de; RIZK, Stephanie Itala; FUKUSHIMA, Julia Tizue; SIMOES, Claudia Marques; RIBEIRO JR., Ulysses; PARK, Clarice Lee; NAKAMURA, Rosana Ely; FRANCO, Rafael Alves; CANDIDO, Patricia Ines; TAVARES, Cintia Rosa; CAMARA, Ligia; FERREIRA, Graziela dos Santos Rocha; ALMEIDA, Elisangela Pinto Marinho de; KALIL FILHO, Roberto; GALAS, Filomena Regina Barbosa Gomes; HAJJAR, Ludhmila Abrahao
    Background: Perioperative goal-directed hemodynamic therapy (GDHT) has been advocated in high-risk patients undergoing noncardiac surgery to reduce postoperative morbidity and mortality. We hypothesized that using cardiac index (CI)-guided GDHT in the postoperative period for patients undergoing high-risk surgery for cancer treatment would reduce 30-day mortality and postoperative complications. Methods: A randomized, parallel-group, superiority trial was performed in a tertiary oncology hospital. All adult patients undergoing high-risk cancer surgery who required intensive care unit admission were randomly allocated to a CI-guided GDHT group or to a usual care group. In the GDHT group, postoperative therapy aimed at CI >= 2.5 L/min/m(2) using fluids, inotropes and red blood cells during the first 8 postoperative hours. The primary outcome was a composite endpoint of 30-day all-cause mortality and severe postoperative complications during the hospital stay. A meta-analysis was also conducted including all randomized trials of postoperative GDHT published from 1966 to May 2017. Results: A total of 128 patients (64 in each group) were randomized. The primary outcome occurred in 34 patients of the GDHT group and in 28 patients of the usual care group (53.1% vs 43.8%, absolute difference 9.4 (95% CI, -7.8 to 25.8); p = 0.3). During the 8-h intervention period more patients in the GDHT group received dobutamine when compared to the usual care group (55% vs 16%, p < 0.001). A meta-analysis of nine randomized trials showed no differences in postoperative mortality (risk ratio 0.85, 95% CI 0.59-1.23; p = 0.4; p for heterogeneity = 0.7; I-2 = 0%) and in the overall complications rate (risk ratio 0.88, 95% CI 0.71-1.08; p = 0.2; p for heterogeneity = 0.07; I-2 = 48%), but a reduced hospital length of stay in the GDHT group (mean difference (MD) - 1.6; 95% CI - 2.75 to -0.46; p = 0.006; p for heterogeneity = 0.002; I-2 = 74%). Conclusions: CI-guided hemodynamic therapy in the first 8 postoperative hours does not reduce 30-day mortality and severe complications during hospital stay when compared to usual care in cancer patients undergoing high-risk surgery.
  • article 19 Citação(ões) na Scopus
    Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial
    (2018) FERREIRA, Graziela Santos Rocha; ALMEIDA, Juliano Pinheiro de; LANDONI, Giovanni; VINCENT, Jean Louis; FOMINSKIY, Evgeny; GALAS, Filomena Regina Barbosa Gomes; GAIOTTO, Fabio A.; DALLAN, Luis Oliveira; FRANCO, Rafael Alves; LISBOA, Luiz Augusto; DALLAN, Luis Roberto Palma; FUKUSHIMA, Julia Tizue; RIZK, Stephanie Itala; PARK, Clarice Lee; STRABELLI, Tania Mara; LAGE, Silvia Helena Gelas; CAMARA, Ligia; ZEFERINO, Suely; JARDIM, Jaquelline; ARITA, Elisandra Cristina Trevisan Calvo; RIBEIRO, Juliana Caldas; AYUB-FERREIRA, Silvia Moreira; AULER JR., Jose Otavio Costa; KALIL FILHO, Roberto; JATENE, Fabio Biscegli; HAJJAR, Ludhmila Abrahao
    Objectives: The aim of this study was to evaluate the efficacy of perioperative intra-aortic balloon pump use in high-risk cardiac surgery patients. Design: A single-center randomized controlled trial and a meta-analysis of randomized controlled trials. Setting: Heart Institute of SAo Paulo University. Patients: High-risk patients undergoing elective coronary artery bypass surgery. Intervention: Patients were randomized to receive preskin incision intra-aortic balloon pump insertion after anesthesia induction versus no intra-aortic balloon pump use. Measurements and Main Results: The primary outcome was a composite endpoint of 30-day mortality and major morbidity (cardiogenic shock, stroke, acute renal failure, mediastinitis, prolonged mechanical ventilation, and a need for reoperation). A total of 181 patients (mean [sd] age 65.4 [9.4] yr; 32% female) were randomized. The primary outcome was observed in 43 patients (47.8%) in the intra-aortic balloon pump group and 42 patients (46.2%) in the control group (p = 0.46). The median duration of inotrope use (51hr [interquartile range, 32-94 hr] vs 39hr [interquartile range, 25-66 hr]; p = 0.007) and the ICU length of stay (5 d [interquartile range, 3-8 d] vs 4 d [interquartile range, 3-6 d]; p = 0.035) were longer in the intra-aortic balloon pump group than in the control group. A meta-analysis of 11 randomized controlled trials confirmed a lack of survival improvement in high-risk cardiac surgery patients with perioperative intra-aortic balloon pump use. Conclusions: In high-risk patients undergoing cardiac surgery, the perioperative use of an intra-aortic balloon pump did not reduce the occurrence of a composite outcome of 30-day mortality and major complications compared with usual care alone.
  • article 9 Citação(ões) na Scopus
    Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial
    (2022) ZANGRILLO, Alberto; LOMIVOROTOV, Vladimir V.; PASYUGA, Vadim V.; BELLETTI, Alessandro; GAZIVODA, Gordana; MONACO, Fabrizio; NETO, Caetano Nigro; LIKHVANTSEV, Valery V.; BRADIC, Nikola; LOZOVSKIY, Andrey; LEI, Chong; BUKAMAL, Nazar A. R.; SILVA, Fernanda Santos; BAUTIN, Andrey E.; MA, Jun; YONG, Chow Yen; CAROLLO, Cristiana; KUNSTYR, Jan; WANG, Chew Yin; V, Evgeny Grigoryev; RIHA, Hynek; WANG, Chengbin; EL-TAHAN, Mohamed R.; SCANDROGLIO, Anna Mara; MANSOR, Marzida; LEMBO, Rosalba; PONOMAREV, Dmitry N.; BEZERRA, Francisco Jose Lucena; RUGGERI, Laura; CHERNYAVSKIY, Alexander M.; XU, Junmei; TARASOV, Dmitry G.; NAVALESI, Paolo; YAVOROVSKIY, Andrey; BOVE, Tiziana; KUZOVLEV, Artem; HAJJAR, Ludhmila A.; LANDONI, Giovanni
    Objective: To investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG). Design: A post hoc analysis of a randomized trial. Setting: Cardiac surgical operating rooms. Participants: Patients undergoing elective, isolated CABG. Interventions: Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48 hours from surgery. The secondary outcome was 1-year death due to cardiac causes. Measurements and Main Results: A total of 5,400 patients were enrolled between April 2014 and September 2017 (2,709 patients randomized to the volatile anesthetics group and 2,691 to TIVA). The mean age was 62 +/- 8.4 years, and the median baseline ejection fraction was 57% (50-67), without differences between the 2 groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v 27 of 2,501 [1.1%] in the TIVA group; p = 0.038) and as-treated analyses (16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p = 0.039), but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of 2,667 [1.0%] in the TIVA group; p = 0.10). Overall, deaths due to cardiac causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668 [1.5%] than in the TIVA group; p = 0.03). Conclusions: An anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.
  • article 94 Citação(ões) na Scopus
    Liberal transfusion strategy improves survival in perioperative but not in critically ill patients. A meta-analysis of randomised trials
    (2015) FOMINSKIY, E.; PUTZU, A.; MONACO, F.; SCANDROGLIO, A. M.; KARASKOV, A.; GALAS, F. R. B. G.; HAJJAR, L. A.; ZANGRILLO, A.; LANDONI, G.
    Background: Guidelines support the use of a restrictive strategy in blood transfusion management in a variety of clinical settings. However, recent randomized controlled trials (RCTs) performed in the perioperative setting suggest a beneficial effect on survival of a liberal strategy. We aimed to assess the effect of liberal and restrictive blood transfusion strategies on mortality in perioperative and critically ill adult patients through a meta-analysis of RCTs. Methods: We searched PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, Transfusion Evidence Library, and Google Scholar up to 27 March 2015, for RCTs performed in perioperative or critically ill adult patients, receiving a restrictive or liberal transfusion strategy, and reporting all-cause mortality. We used a fixed or random-effects model to calculate the odds ratio (OR) and 95% confidence interval (CI) for pooled data. We assessed heterogeneity using Cochrane's Q and I-2 tests. The primary outcome was all-cause mortality within 90-day follow-up. Results: Patients in the perioperative period receiving a liberal transfusion strategy had lower all-cause mortality when compared with patients allocated to receive a restrictive transfusion strategy (OR 0.81; 95% CI 0.66-1.00; P=0.05; I-2=25%; Number needed to treat=97) with 7552 patients randomized in 17 trials. There was no difference in mortality among critically ill patients receiving a liberal transfusion strategy when compared with the restrictive transfusion strategy (OR 1.10; 95% CI 0.99-1.23; P=0.07; I-2=34%) with 3469 patients randomized in 10 trials. Conclusion: According to randomized published evidence, perioperative adult patients have an improved survival when receiving a liberal blood transfusion strategy.
  • article 157 Citação(ões) na Scopus
    Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery
    (2019) LANDONI, Giovanni; LOMIVOROTOV, Vladimir V.; NETO, Caetano Nigro; MONACO, Fabrizio; PASYUGA, Vadim V.; BRADIC, Nikola; LEMBO, Rosalba; GAZIVODA, Gordana; LIKHVANTSEV, Valery V.; LEI, Chong; LOZOVSKIY, Andrey; TOMASSO, Nora Di; BUKAMAL, Nazar A. R.; SILVA, Fernanda S.; BAUTIN, Andrey E.; MA, Jun; CRIVELLARI, Martina; FARAG, Ahmed M. G. A.; UVALIEV, Nikolay S.; CAROLLO, Cristiana; PIERI, Marina; KUNSTYR, Jan; WANG, Chew Yin; BELLETTI, Alessandro; HAJJAR, Ludhmila A.; GRIGORYEV, Evgeny V.; AGRO, Felice E.; RIHA, Hynek; EL-TAHAN, Mohamed R.; SCANDROGLIO, A. Mara; ELNAKERA, Abeer M.; BAIOCCHI, Massimo; NAVALESI, Paolo; SHMYREV, Vladimir A.; SEVERI, Luca; HEGAZY, Mohammed A.; CRESCENZI, Giuseppe; PONOMAREV, Dmitry N.; BRAZZI, Luca; ARNONI, Renato; TARASOV, Dmitry G.; JOVIC, Miomir; CALABRO, Maria G.; BOVE, Tiziana; BELLOMO, Rinaldo; ZANGRILLO, Alberto
    BACKGROUND Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG). METHODS We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year. RESULTS A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts. At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility. No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P=0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%). There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction. CONCLUSIONS Among patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia.
  • article 4 Citação(ões) na Scopus
    Continuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac Surgery: A Sequential Matched Case-Controlled Pilot Study
    (2020) OSAWA, Eduardo A.; CUTULI, Salvatore L.; CIOCCARI, Luca; BITKER, Laurent; PECK, Leah; YOUNG, Helen; HESSELS, Lara; YANASE, Fumitaka; FUKUSHIMA, Julia T.; HAJJAR, Ludhmila A.; SEEVANAYAGAM, Siven; MATALANIS, George; EASTWOOD, Glenn M.; BELLOMO, Rinaldo
    Objective: The authors aimed to test whether a bolus of magnesium followed by continuous intravenous infusion might prevent the development of atrial fibrillation (AF) after cardiac surgery. Design: Sequential, matched, case-controlled pilot study. Setting: Tertiary university hospital. Participants: Matched cohort of 99 patients before and intervention cohort of 99 consecutive patients after the introduction of a continuous magnesium infusion protocol. Interventions: The magnesium infusion protocol consisted of a 10 mmol loading dose of magnesium sulphate followed by a continuous infusion of 3 mmol/h over a maximum duration of 96 hours or until intensive care unit discharge. Measurements and Main Results: The study groups were balanced except for a lower cardiac index in the intervention cohort. The mean duration of magnesium infusion was 27.93 hours (95% confidence interval [CI]: 24.10-31.76 hours). The intervention group had greater serum peak magnesium levels: 1.72 mmol/L 0.34 on day 1, 1.32 0.36 on day 2 versus 1.01 +/- 1.14 and 0.97 +/- 0.13, respectively, in the control group (p < 0.01). Atrial fibrillation occurred in 25 patients (25.3%) in the intervention group and 40 patients (40.4%) in the control group (odds ratio 0.49, 95% CI, 0.27-0.92; p = 0.023). On a multivariate Cox proportional hazards model, the hazard ratio for the development of AF was significantly less in the intervention group (hazard ratio 0.45, 95% CI, 0.26-0.77; p = 0.004). Conclusion: The magnesium delivery strategy was associated with a decreased incidence of postoperative AF in cardiac surgery patients. These findings provide a rationale and preliminary data for the design of future randomized controlled trials.
  • article 15 Citação(ões) na Scopus
    A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Reducing Mortality
    (2019) SARTINI, Chiara; LOMIVOROTOV, Vladimir; PIERI, Manna; LOPEZ-DELGADO, Juan Carlos; REDAELLI, Martina Baiardo; HAJJAR, Ludhmila; PISANO, Antonio; LIKHVANTSEV, Valery; FOMINSKIY, Evgeny; BRADIC, Nikola; CABRINI, Luca; NOVIKOV, Maxim; AVANCINI, Daniele; RIHA, Hynek; LEMBO, Rosalba; GAZIVODA, Gordana; PATERNOSTER, Gianluca; WANG, Chengbin; TAMA, Simona; ALVARO, Gabriele; WANG, Chew Yin; ROASIO, Agostino; RUGGERI, Laura; YONG, Chow-Yen; PASERO, Daniela; SEVERI, Luca; PASIN, Laura; MANCINO, Giuseppe; MURA, Paolo; MUSU, Mario; SPADARO, Savino; CONTE, Massimiliano; LOBREGLIO, Rosetta; SILVETTI, Simona; VOTTA, Carmine Domenico; BELLETTI, Alessandro; FRAJA, Diana Di; CORRADI, Francesco; BRUSASCO, Claudia; SAPORITO, Emanuela; D'AMICO, Alessandro; SARDO, Salvatore; ORTALDA, Alessandro; RIEFOLO, Claudio; FABRIZIO, Monaco; ZANGRILLO, Alberto; BELLOMO, Rinaldo; LANDONI, Giovanni
    The authors aimed to identify interventions documented by randomized controlled trials (RCTs) that reduce mortality in adult critically ill and perioperative patients, followed by a survey of clinicians' opinions and routine practices to understand the clinicians' response to such evidence. The authors performed a comprehensive literature review to identify all topics reported to reduce mortality in perioperative and critical care settings according to at least 2 RCTs or to a multicenter RCT or to a single-center RCT plus guidelines. The authors generated position statements that were voted on online by physicians worldwide for agreement, use, and willingness to include in international guidelines. From 262 RCT manuscripts reporting mortality differences in the perioperative and critically ill settings, the authors selected 27 drugs, techniques, and strategies (66 RCTs, most frequently published by the New England Journal of Medicine [13 papers], Lancet [7], and Journal of the American Medical Association [5]) with an agreement >= 67% from over 250 physicians (46 countries). Noninvasive ventilation was the intervention supported by the largest number of RCTs (n = 13). The concordance between agreement and use (a positive answer both to ""do you agree"" and ""do you use"") showed differences between Western and other countries and between anesthesiologists and intensive care unit physicians. The authors identified 27 clinical interventions with randomized evidence of survival benefit and strong clinician support in support of their potential life-saving properties in perioperative and critically ill patients with noninvasive ventilation having the highest level of support. However, clinician views appear affected by specialty and geographical location.
  • article 26 Citação(ões) na Scopus
    Vasopressin Versus Norepinephrine for the Management of Septic Shock in Cancer Patients: The VANCS II Randomized Clinical Trial*
    (2019) HAJJAR, Ludhmila Abrahao; ZAMBOLIM, Cristiane; BELLETTI, Alessandro; ALMEIDA, Juliano Pinheiro de; GORDON, Anthony C.; OLIVEIRA, Gisele; PARK, Clarice Hyesuk Lee; FUKUSHIMA, Julia Tizue; RIZK, Stephanie Itala; SZELES, Tais Felix; SANTOS NETO, Nestor Cordeiro dos; KALIL FILHO, Roberto; GALAS, Filomena Regina Barbosa Gomes; LANDONI, Giovanni
    Objectives: Previous trials suggest that vasopressin may improve outcomes in patients with vasodilatory shock. The aim of this study was to evaluate whether vasopressin could be superior to norepinephrine to improve outcomes in cancer patients with septic shock. Design: Single-center, randomized, double-blind clinical trial, and meta-analysis of randomized trials. Setting: ICU of a tertiary care hospital. Patients: Two-hundred fifty patients 18 years old or older with cancer and septic shock. Interventions: Patients were assigned to either vasopressin or norepinephrine as first-line vasopressor therapy. An updated meta-analysis was also conducted including randomized trials published until October 2018. Measurements and Main Results: The primary outcome was all-cause mortality at 28 days after randomization. Prespecified secondary outcomes included 90-days all-cause mortality rate; number of days alive and free of advanced organ support at day 28; and Sequential Organ Failure Assessment score 24 hours and 96 hours after randomization. We also measure the prevalence of adverse effects in 28 days. A total of 250 patients were randomized. The primary outcome was observed in 71 patients (56.8%) in the vasopressin group and 66 patients (52.8%) in the norepinephrine group (p = 0.52). There were no significant differences in 90-day mortality (90 patients [72.0%] and 94 patients [75.2%], respectively; p = 0.56), number of days alive and free of advanced organ support, adverse events, or Sequential Organ Failure Assessment score. Conclusions: In cancer patients with septic shock, vasopressin as first-line vasopressor therapy was not superior to norepinephrine in reducing 28-day mortality rate.
  • article 63 Citação(ões) na Scopus
    Alternatives to the Swan-Ganz catheter
    (2018) BACKER, Daniel De; BAKKER, Jan; CECCONI, Maurizio; HAJJAR, Ludhmila; LIU, Da Wei; LOBO, Suzanna; MONNET, Xavier; MORELLI, Andrea; MYATRA, Sheila Neinan; PEREL, Azriel; PINSKY, Michael R.; SAUGEL, Bernd; TEBOUL, Jean-Louis; VIEILLARD-BARON, Antoine; VINCENT, Jean-Louis
    While the pulmonary artery catheter (PAC) is still interesting in specific situations, there are many alternatives. A group of experts from different backgrounds discusses their respective interests and limitations of the various techniques and related measured variables. The goal of this review is to highlight the conditions in which the alternative devices will suffice and when they will not or when these alternative techniques can provide information not available with PAC. The panel concluded that it is useful to combine different techniques instead of relying on a single one and to adapt the ""package"" of interventions to the condition of the patient. As a first step, the clinical and biologic signs should be used to identify patients with impaired tissue perfusion. Whenever available, echocardiography should be performed as it provides a rapid and comprehensive hemodynamic evaluation. If the patient responds rapidly to therapy, either no additional monitoring or pulse wave analysis (allowing continuous monitoring in case potential degradation is anticipated) can be applied. If the patient does not rapidly respond to therapy or complex hemodynamic alterations are observed, pulse wave analysis coupled with TPTD is suggested.