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Clinical Management of Endotoxemia: Vasoactive and Cardiostimulant Drugs

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Endotoxin Induced-Shock: a Multidisciplinary Approach in Critical Care

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Abstract

This chapter provides information on the clinical use of vasoactive and inotropic drugs in patients with endotoxin-induced septic shock. Vasoplegia and myocardial stunning are well-known effects of lipopolysaccharide. Vasopressor and cardiostimulant drugs may be beneficial in hyperdynamic or hypodynamic shock observed during endotoxemia. In fact, catecholamines are considered a key treatment for septic shock patients who have been adequately resuscitated with fluids and are under hemodynamic monitoring.

The Surviving Sepsis Guidelines recommend using norepinephrine as the first-line vasopressor for the treatment of hypotension in septic shock patients. However, a combination of different vasoactive drugs can be used to reduce their doses and, ultimately, their potential side effects. The adoption of vasopressor and/or inotropic drugs should be based on specific pathophysiological derangements affecting the hemodynamic stability of each patient. Targeted hemodynamic monitoring is therefore necessary to effectively guide the prescription of vasoactive and cardiostimulant drugs in patients with endotoxic shock.

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Authors and Affiliations

  1. School of Anesthesia and Critical Care, University of Florence, Florence, Italy

    Giulia Cocci & Raffaella d’Errico

  2. Department of Health Science, University of Florence, Florence, Italy

    Gianluca Villa & Stefano Romagnoli

  3. Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Gianluca Villa & Stefano Romagnoli

Authors
  1. Giulia Cocci
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  2. Raffaella d’Errico
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  3. Gianluca Villa
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  4. Stefano Romagnoli
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Correspondence to Giulia Cocci .

Editor information

Editors and Affiliations

  1. Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Centre for Medical Sciences - CISMed University of Trento, Via S. Maria Maddalena, Trento, Italy

    Silvia De Rosa

  2. Anesthesiology and Intensive Care, Dept. of Health Science, University of Florence, Firenze, Italy

    Gianluca Villa

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Cocci, G., d’Errico, R., Villa, G., Romagnoli, S. (2023). Clinical Management of Endotoxemia: Vasoactive and Cardiostimulant Drugs. In: De Rosa, S., Villa, G. (eds) Endotoxin Induced-Shock: a Multidisciplinary Approach in Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-031-18591-5_9

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  • DOI: https://doi.org/10.1007/978-3-031-18591-5_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-18590-8

  • Online ISBN: 978-3-031-18591-5

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