Nitro for sepsis/septic shock

So giving vasodilators to patients who are already vasodilated doesn't work too well?

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(I had to, JP. It fit too well)
 
Like always the comments on the Facebook page are amusing. You can tell the majority have no clue.

I will have to dig through that study later but the concept is interesting.

From what I understand the nitro is given after fluid resuscitation has occurred and the patients are relatively hemodynamicly stable. It is not used in the early stages while they are still hypotensive. The goal is to improve microcircualtion in the smaller vasculuture that has been shunted and ischemic since the early stages of shock and is accumulating lactic acid. Just because the systemic major vessels are dilated does not mean that vascular beds and microvessels are not constricted. It sounds like nitro given in the presence of septic shock dilates those areas without a resulting systemic dilation. Which is beneficial.
 
Chase said:
Like always the comments on the Facebook page are amusing. You can tell the majority have no clue.

I will have to dig through that study later but the concept is interesting.

From what I understand the nitro is given after fluid resuscitation has occurred and the patients are relatively hemodynamicly stable. It is not used in the early stages while they are still hypotensive. The goal is to improve microcircualtion in the smaller vasculuture that has been shunted and ischemic since the early stages of shock and is accumulating lactic acid. Just because the systemic major vessels are dilated does not mean that vascular beds and microvessels are not constricted. It sounds like nitro given in the presence of septic shock dilates those areas without a resulting systemic dilation. Which is beneficial.
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...except no difference (and I don't mean a P=0.06 nonsense. p=80... same means, higher fatality rate) was seen in the small study looking at outcomes.
 
Chase said:
Like always the comments on the Facebook page are amusing. You can tell the majority have no clue.
Click to expand...

I haven't looked at the study, but I definitely agree about the FB comments. It is always amusing to see how strongly people hold to their convictions about things that they know very little about.

None of those folks even seem aware that early sepsis can present with a hyperdynamic phase in which intense vasoconstriction is a feature.

It seems plausible that interrupting this phase and improving local perfusion could play a beneficial role in preventing the subsequent inflammatory response which causes the classic features of septic shock. Seems worth investigating anyway.
 
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