Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Optimal vasopressor drug therapy during resuscitation. | Available online http content 12 2 123 Commentary Optimal vasopressor drug therapy during resuscitation Joseph P Ornato Department of Emergency Medicine Virginia Commonwealth University East Marshall Street Richmond Virginia 23298-0401 USA Corresponding author Joseph P Ornato ornato@ Published 31 March 2008 This article is online at http content 12 2 123 2008 BioMed Central Ltd Critical Care 2008 12 123 doi cc6824 See related research by Stroumpoulis et al. http content 12 2 R40 Abstract Optimal vasopressor support during resuscitation should theoretically enhance aortic diastolic and coronary perfusion pressure as well as coronary and cerebral blood flow oxygen delivery without increasing cellular oxygen demand. Intravenous vasopressor support using 1 mg doses of epinephrine every 5 minutes in adults or vasopressin 40 IU is recommended by American Heart Association Advanced Cardiac Life Support Guidelines to maximize oxygen delivery to the heart and brain and increase cellular high energy phosphate levels. Vasopressin offers theoretical advantages over epinephrine in that it does not increase myocardial oxygen demand significantly and its receptors are relatively unaffected by acidosis. However unlike epinephrine it is not a myocardial stimulant. Despite these differences in physiologic actions two large randomized clinical trials yielded virtually identical overall survival to hospital discharge when these agents were compared during inhospital or out-of-hospital resuscitation in Canada and Europe respectively. More recent clinical and experimental evidence suggests that a combination of vasopressin and epinephrine used during resuscitation can improve hemodynamics and perhaps survival. The verdict on a combination vasopressor strategy may soon come from a large 2 000 patients prospective clinical trial that is underway in France to clarify the role of combination vasopressin epinephrine therapy in .
