Shock - Classification and Pathophysiological Principles of Therapeutics

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

The management of patients with shock is extremely challenging because of the myriad of possible clinical presentations in cardiogenic shock, septic shock and hypovolemic shock and the limitations of contemporary therapeutic options. The treatment of shock includes the administration of endogenous catecholamines (epinephrine, norepinephrine, and dopamine) as well as various vasopressor agents that have shown efficacy in the treatment of the various types of shock. In addition to the endogenous catecholamines, dobutamine, isoproterenol, phenylephrine, and milrinone have served as the mainstays of shock therapy for several decades. Recently, experimental studies have suggested that newer agents such as vasopressin, selepressin, calcium-sensitizing agents like levosimendan, cardiac-specific myosin activators like omecamtiv mecarbil (OM), istaroxime, and natriuretic peptides like nesiritide can enhance shock therapy, especially when shock presents a more complex clinical picture than normal. However, their ability to improve clinical outcomes remains to be proven. It is the purpose of this review to describe the mechanism of action, dosage requirements, advantages and disadvantages, and specific indications and contraindications for the use of each of these catecholamines and vasopressors, as well as to elucidate the most important clinical trials that serve as the basis of contemporary shock therapy.

Original languageEnglish (US)
Pages (from-to)102-113
Number of pages12
JournalCurrent cardiology reviews
Volume15
Issue number2
DOIs
StatePublished - Jan 1 2019

Fingerprint

Shock
Convulsive Therapy
Catecholamines
Milrinone
Cardiac Myosins
Therapeutics
Natriuretic Peptides
Aptitude
Dobutamine
Cardiogenic Shock
Brain Natriuretic Peptide
Phenylephrine
Vasoconstrictor Agents
Septic Shock
Vasopressins
Isoproterenol
Epinephrine
Dopamine
Norepinephrine
Clinical Trials

Keywords

  • cardiogenic shock
  • endogenous catecholamines
  • exogenous catecholamines
  • inotropes
  • septic shock
  • Shock
  • shock therapy
  • vasopressors.

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{3002a078712d408abefa008d301c5692,
title = "Shock - Classification and Pathophysiological Principles of Therapeutics",
abstract = "The management of patients with shock is extremely challenging because of the myriad of possible clinical presentations in cardiogenic shock, septic shock and hypovolemic shock and the limitations of contemporary therapeutic options. The treatment of shock includes the administration of endogenous catecholamines (epinephrine, norepinephrine, and dopamine) as well as various vasopressor agents that have shown efficacy in the treatment of the various types of shock. In addition to the endogenous catecholamines, dobutamine, isoproterenol, phenylephrine, and milrinone have served as the mainstays of shock therapy for several decades. Recently, experimental studies have suggested that newer agents such as vasopressin, selepressin, calcium-sensitizing agents like levosimendan, cardiac-specific myosin activators like omecamtiv mecarbil (OM), istaroxime, and natriuretic peptides like nesiritide can enhance shock therapy, especially when shock presents a more complex clinical picture than normal. However, their ability to improve clinical outcomes remains to be proven. It is the purpose of this review to describe the mechanism of action, dosage requirements, advantages and disadvantages, and specific indications and contraindications for the use of each of these catecholamines and vasopressors, as well as to elucidate the most important clinical trials that serve as the basis of contemporary shock therapy.",
keywords = "cardiogenic shock, endogenous catecholamines, exogenous catecholamines, inotropes, septic shock, Shock, shock therapy, vasopressors.",
author = "Kislitsina, {Olga Nikolaevna} and Rich, {Jonathan D} and Wilcox, {Jane E} and Pham, {Duc Thinh} and Andrei Churyla and Vorovich, {Esther Elizabeth} and Kambiz Ghafourian and Yancy, {Clyde W}",
year = "2019",
month = "1",
day = "1",
doi = "10.2174/1573403X15666181212125024",
language = "English (US)",
volume = "15",
pages = "102--113",
journal = "Current Cardiology Reviews",
issn = "1573-403X",
publisher = "Bentham Science Publishers B.V.",
number = "2",

}

TY - JOUR

T1 - Shock - Classification and Pathophysiological Principles of Therapeutics

AU - Kislitsina, Olga Nikolaevna

AU - Rich, Jonathan D

AU - Wilcox, Jane E

AU - Pham, Duc Thinh

AU - Churyla, Andrei

AU - Vorovich, Esther Elizabeth

AU - Ghafourian, Kambiz

AU - Yancy, Clyde W

PY - 2019/1/1

Y1 - 2019/1/1

N2 - The management of patients with shock is extremely challenging because of the myriad of possible clinical presentations in cardiogenic shock, septic shock and hypovolemic shock and the limitations of contemporary therapeutic options. The treatment of shock includes the administration of endogenous catecholamines (epinephrine, norepinephrine, and dopamine) as well as various vasopressor agents that have shown efficacy in the treatment of the various types of shock. In addition to the endogenous catecholamines, dobutamine, isoproterenol, phenylephrine, and milrinone have served as the mainstays of shock therapy for several decades. Recently, experimental studies have suggested that newer agents such as vasopressin, selepressin, calcium-sensitizing agents like levosimendan, cardiac-specific myosin activators like omecamtiv mecarbil (OM), istaroxime, and natriuretic peptides like nesiritide can enhance shock therapy, especially when shock presents a more complex clinical picture than normal. However, their ability to improve clinical outcomes remains to be proven. It is the purpose of this review to describe the mechanism of action, dosage requirements, advantages and disadvantages, and specific indications and contraindications for the use of each of these catecholamines and vasopressors, as well as to elucidate the most important clinical trials that serve as the basis of contemporary shock therapy.

AB - The management of patients with shock is extremely challenging because of the myriad of possible clinical presentations in cardiogenic shock, septic shock and hypovolemic shock and the limitations of contemporary therapeutic options. The treatment of shock includes the administration of endogenous catecholamines (epinephrine, norepinephrine, and dopamine) as well as various vasopressor agents that have shown efficacy in the treatment of the various types of shock. In addition to the endogenous catecholamines, dobutamine, isoproterenol, phenylephrine, and milrinone have served as the mainstays of shock therapy for several decades. Recently, experimental studies have suggested that newer agents such as vasopressin, selepressin, calcium-sensitizing agents like levosimendan, cardiac-specific myosin activators like omecamtiv mecarbil (OM), istaroxime, and natriuretic peptides like nesiritide can enhance shock therapy, especially when shock presents a more complex clinical picture than normal. However, their ability to improve clinical outcomes remains to be proven. It is the purpose of this review to describe the mechanism of action, dosage requirements, advantages and disadvantages, and specific indications and contraindications for the use of each of these catecholamines and vasopressors, as well as to elucidate the most important clinical trials that serve as the basis of contemporary shock therapy.

KW - cardiogenic shock

KW - endogenous catecholamines

KW - exogenous catecholamines

KW - inotropes

KW - septic shock

KW - Shock

KW - shock therapy

KW - vasopressors.

UR - http://www.scopus.com/inward/record.url?scp=85063259144&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063259144&partnerID=8YFLogxK

U2 - 10.2174/1573403X15666181212125024

DO - 10.2174/1573403X15666181212125024

M3 - Article

VL - 15

SP - 102

EP - 113

JO - Current Cardiology Reviews

JF - Current Cardiology Reviews

SN - 1573-403X

IS - 2

ER -