Статья

Adrenergic Downregulation in Critical Care: Molecular Mechanisms and Therapeutic Evidence

A. Belletti, G. Landoni, V. Lomivorotov, A. Oriani, S. Ajello,
2020

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.

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  • 1. Version of Record от 2020-04-01

Метаданные

Об авторах
  • A. Belletti
    IRCCS San Raffaele Scientific Institute
  • G. Landoni
    IRCCS San Raffaele Scientific Institute, Università Vita-Salute San Raffaele
  • V. Lomivorotov
    E.N. Meshalkin National Medical Research Center, Novosibirsk State University
  • A. Oriani
    IRCCS San Raffaele Scientific Institute
  • S. Ajello
    IRCCS San Raffaele Scientific Institute
Название журнала
  • Journal of Cardiothoracic and Vascular Anesthesia
Том
  • 34
Выпуск
  • 4
Страницы
  • 1023-1041
Номер гранта
  • undefined
Тип документа
  • journal article
Тип лицензии Creative Commons
  • CC BY
Правовой статус документа
  • Свободная лицензия
Источник
  • scopus