Thread by @MABonizzoni

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🎬 Now on stage Professor @giovannilandoni talking about what we DON'T KNOW about #cardiocirculatory drugs

✅ #Norepineprhine is the most used vasoactive drug in the guidelines for:

🔹 #sepsis
🔹#cardiogenic shock❗(Scandinavian)

BUT...

@Smart_Meeting_M @SRAnesthesiaICU

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BUT... #Norepineprhine (base) does not exist❗

🚫 base is not soluble, unstable and unable to reach target receptors
💡 Let's make it a salt!
🤔 But which one?

⚠️ Available Norepineprhine salts has different #dilution
⚠️ Sometimes with misleading #labeling

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➡️ Please do not change you're clinical practice for this ⬅️

But consider the possible implications on:

🔹Second line drugs initiation
🔹Co- administration of other vasopressors
❗Comunication of your results!!!

pubmed.ncbi.nlm.nih.gov/36978126/

#FOAMed #FOAMcc

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But we know little also about

❗Fluids
❗Patients position

Did you know that we keep patients with 45 degrees raised back following a RCT with only 38 patients and showing no difference in mortality?

pubmed.ncbi.nlm.nih.gov/10584721/

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😳Look at the enormous #difference in the use of vasoactive drugs among USA hospitals in THE SAME patients category (#cardiac #surgery)

#FOAMed #FOAMcc

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Metanalysis on vasopressors compared to placebo.

➡️ Overall no difference in mortality!!

✅ Lifesaving in #vasoplegic syndromes, #sepsis and #cardiac surgery.

pubmed.ncbi.nlm.nih.gov/26475799/

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💡And did you know there is a third vasopressor category!?

#AngiotensinII

With a significant effect in #MAP augmentation ↗️

pubmed.ncbi.nlm.nih.gov/28528561/

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Here's how to communicate the severity of shock of your patients!

✅Updated Vasoactive Inotropic Score #VIS including also Angiotensin II

pubmed.ncbi.nlm.nih.gov/33069558/

✅Updated Norepinephrine Equivalent

pubmed.ncbi.nlm.nih.gov/36670410/