Adrenergic Downregulation in Critical Care: Molecular Mechanisms and Therapeutic Evidence

Alessandro Belletti, Giovanni Landoni, Vladimir V. Lomivorotov, Alessandro Oriani, Silvia Ajello

Результат исследования: Научные публикации в периодических изданияхобзорная статья

1 Цитирования (Scopus)

Аннотация

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, β-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.

Язык оригиналаанглийский
Страницы (с-по)1023-1041
Число страниц19
ЖурналJournal of Cardiothoracic and Vascular Anesthesia
Том34
Номер выпуска4
Ранняя дата в режиме онлайн16 окт 2019
DOI
СостояниеОпубликовано - апр 2020

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