HİPOTANSİYON TEDAVİSİ : DOĞRU BİLİNEN YANLIŞLAR ve VAZOPRESSÖR AJANLARIN GÜNCELLEMESİ

Yıl 2020, , 52 - 57, 26.03.2020

Sena Ulu , Sinan Kazan , Özkan Güngör

https://doi.org/10.17517/ksutfd.658161

Öz

Hipotansiyon hızlı bir şekilde düzeltilmediğinde şok tablosu dediğimiz ve doku perfüzyonunda bozulma, multiorgan yetmezliği ve ölüm görülebilir. Vazopresörler, vazokonstrüksiyonla Kan basıncını artıran ajanlardır ve etkilerini adrenerjik sistem reseptörleri üzerinden gösterirler. Bu reseptörlerin yeri ve vazoaktif ajanlara cevapları değişkendir. Önceki yıllarda hipotansiyonda, ilk tercih olarak dopamin kullanılırken, son yıllarda yapılan çalışma ve metaanalizlerde dopaminin yüksek aritmi ve iskemi riski ile immün sistem üzerine olumsuz etkilerinin tespit edilmesiyle, dopaminin güvenliği ile ilgili ciddi endişeler ortaya çıkmıştır. Yine eskiden hipotansiyonda ikinci seçenek olarak düşünülen norepinefrin, son yıllarda birçok çalışmada, şokta sıvı desteği sağlandıktan sonra, ilk tercih edilecek ajanlardan biri olarak önerilmektedir. Son yılarda popülarite kazanmış bir ajan olan Vazopresin de, güçlü vazopressör etkisi ve düşük yan etki profili ile son klavuzlarda, etkin vazopressör ajanlardan biri olarak yerini almıştır. Bu gelişmelerin yanında, yoğun bakım dışındaki anesteziye bağlı hipotansiyon hastalarında da tercih edilmesi gereken ajanlarla ilgili güncel gelişmeler olmuştur.
Bu derlemede, hipotansiyon ve şok tedavisinde, elimizde bulunan güncel veriler ve klavuzlar eşliğinde, vazopresör ajanlar incelenmiş, doğru bilinen yanlışlara da yer verilerek, hipotansiyon tedavisi derlenerek, pratik yaklaşıma değinilmiştir.

Anahtar Kelimeler

Vazopresör, Hipotansiyon, Septik şok

Kaynakça

• 1. Stanchina ML, Levy MM. Vasoactive drug use in septic shock. Semin Respir Crit Care Med 2004 Dec;25(6):673-81.
• 2. Vincent JL, De Backer D. Inotrope/vasopressor support in sepsis induced organ hypoperfusion. Semin Respir Crit Care Med 2001;22(1):61-74.
• 3. Aronson S, Mythen MG. Perioperative Management of High-Risk Patients: Going Beyond "Avoid Hypoxia and Hypotension" JAMA 2017 Oct 10;318(14):1330-2
• 4. Dellinger RP. Cardiovascular management of septic shock. Crit Care Med 2003;31:946-55
• 5. Hensyl WR. Stedman’s medical Dictionary (25 th ed.) Baltimore: Williams and Wilkins, 1990
• 6. Bangash MN, Kong ML, Pearse RM. Use of inotropes and vasopressor agents in critically ill patients. Br J Pharmacol 2012 Apr;165(7):2015-33
• 7. Levy JH. Treating shock--old drugs, new ideas. N Engl J Med 2010 Mar;362(9):841-43
• 8. Tabaee A. Pharmacologic management of the hypotensive patient. In: Intensive Care Medicine (5 th ed.) Philadelphia: Lippincott Williams and Wilkins, 2003
• 9. Lee RW, Di Giantomasso D, May C, Bellomo R. Vasoactive drugs and the kidney. Best Pract Res Clin Anaesthesiol 2004 Mar;18(1):53-74.
• 10. Port JD, Gilbert EM, Larrabee P, Mealey P, Volkman K, Ginsburg R, et al. Neurotransmitter depletion compromises the ability of indirect-acting amines to provide inotropic support in the failing human heart. Circulation 1990 Mar;81(3):929-38.
• 11. Hollenberg SM, Ahrens TS, Annane D, Astiz ME, Chalfin DB, Dasta JF, et al. Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 2004 Sep;32(9):1928-48
• 12. Argalious M, Motta P, Khandwala F, Samuel S, Koch CG, Gillinov AM, et al. ‘Renal dose’ dopamine is associated with the risk of new onset atrial fibrillation after cardiac surgery. Crit Care Med 2005;33:1327-32
• 13. McDonald RH, Goldberg LI, McNay JL, Tuttle EP. Effects of dopamine in man. augmentation of sodium excretion, glomerular filtration rate and renal plasma flow. J Clin Invest 1964 Jun; 43(6): 1116–24
• 14. Sasser JM, Baylis C. The natriuretic and diuretic response to dopamine is maintained during rat pregnancy. Am J Physiol Renal Physiol. 2008 Jun;294(6):F1342-44
• 15. Bertorello A, Aperia A. Inhibition of proximal tubule Na(+)-K(+)-ATPase activity requires simultaneous activation of DR1 and DR2 receptors. Am J Physiol 1990 Jan;256(1 Pt 2):F57-62
• 16. Lokhandwala MF, Amenta F. Anatomical distribution and function of dopamine receptors in the kidney. FASEBJ 1991 Dec;5(15):3023-30.
• 17. Kellum JA, Decker JM. Use of dopamine in acute renal failure: A meta-analysis. Crit Care Med 2001;29:1526-31.
• 18. Marik PE. Low-dose dopamin: A systematic review. Intensive Care Med 2002;28:877-83.
• 19. Holmes CL. Vasoactive drugs in the intensive care unit. Curr Opin Crit Care 2005;11:413-7
• 20. Hernandez G, Bruhn A, Romero C, Javier Larrondo F, De La Fuente R, Castillo L, et al. Management of septic shock with a norepinephrine-based haemodynamic algortihm. Resuscitation 2005 Jul;66(1):63-9
• 21. Martin C, Viviand X, Leone M, Thirion X. Effect of norepinephrine on the outcome of septic shock. Crit Care Med. 2000 Aug;28(8):2758-65.
• 22. Albanèse J, Leone M, Garnier F, Bourgoin A, Antonini F, Martin C. Renal effects of norepinephrine in septic and nonseptic patients. Chest 2004 Aug;126(2):534-9.
• 23.Nolan JP, Soar J, Cariou A, Cronberg T, Moulaert VR, Deakin CD, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines. Resuscitation. 2015 95:202-22
• 24. Bishop DG, Cairns C, Grobbelaar M, Rodseth RN. Prophylactic Phenylephrine Infusions to Reduce Severe Spinal Anesthesia Hypotension During Cesarean Delivery in a Resource-Constrained Environment. Anesth Analg. 2017 Sep;125(3):904-6.
• 25. Bennett SR, McKeown J, Drew P, Griffin S. Angiotensin in cardiac surgery: efficacy in patients on angiotensin converting enzyme inhibitors. The Eur J Heart Failure 2001: 587-92
• 26. Holmes CL, Walley KR, Chittock DR, Lehman T, Russell JA. The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series. Intensive Care Med 2001 Aug;27(8):1416-21.
• 27 . Dunser MW, Mayr AJ, Ulmer H, Knotzer H, Sumann G, Paik W, et al. Arginine vasopressin in advanced vasodilatory shock: a prospective, randomized, controlled study. Circulation 2003;107(18):2313-19.
• 28. Russell JA, Walley KR, Singer J, Gordon AC, Hebert PC, Cooper DJ, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 2008;358(9):877-87.
• 29. Kang CH, Kim WG. The effect of vasopressin on organ blood flow in an endotoxin-induced rabbit shock model J Invest Surg. 2006 Nov-Dec;19(6):361-9
• 30. Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle : 2018 update. Crit Care Med 2018 Jun;46(6):997-1000
• 31. Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary: Critical Care, Perioperative and Resuscitation. Resuscitation. 2015 Nov;96:328-40
• 32. Lindner KH, Dirks B, Strohmenger HU, Prengel AW, Lindner IM, Lurie KG. Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation. Lancet 1997 Feb 22;349(9051):535-7.
• 33. Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell R, Mercier FJ, et al. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018 Jan;73(1):71-92.
• 34. Chooi C, Cox JJ, Lumb RS, Middleton P, Chemali M, Emmett RS, et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2017 Aug 4;8:CD002251.
• 35. Girbes AR. Prevention of acute renal failure. role of vaso-active drugs, mannitol and diuretics. Int J Artif Organs 2004 Dec;27(12):1049-53.
• 36. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001 Nov 8;345(19):1368-77.
• 37. Natalini G, Schivalocchi V, Rosano A, Taranto M, Pletti C, Bernardini A. Norepinephrine and metaraminol in septic shock: a comparison of the hemodynamic effects. Intensive Care Med 2005 May;31(5):634-7.
• 38. Garwood S, Swamidoss CP, Davis EA, Samson L, Hines RL. A case series of low-dose fenoldopam in seventy cardiac surgical patients at increased risk of renal dysfunction. J Cardiothorac Vasc Anesth 2003;17(1):17-21.
• 39. Halpenny M, Lakshmi S, O'Donnell A, O'-Callaghan-Enrighipotansiyon S, Shorten GD. Fenoldopam: renal and splanchnic effects in patients undergoing coronary artery bypass grafting. Anaesthesia 2001;56(10):953-60
• 40. Brienza N, Malcangi V, Dalfino L, Trerotoli P, Guagliardi C, Bortone D, et al. A comparison between fenoldopam and low-dose dopamine in early renal dysfunction of critically ill patients. Crit Care Med 2006;34(3):707-14
• 41. De Backer D, Creteur J, Silva E, Vincent JL. Effects of dopamine, norepinephrine and epinephrine on the splanchnic circulation in septic shock: Which is best? Crit Care Med 2003;31:1659-67
• 42. De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779-89.
• 43. Beale RJ, Hollenberg SM, Vincent JL, Parrillo JE. Vasopressor and inotropic support in septic shock: An evidence-based review. Crit Care Med 2004 Nov;32(11 Suppl):455-65
• 44. Russell JA. Management of sepsis. N Eng J Med 2006 Oct 19;355(16):1699-1713
• 45. Raimundo M, Crichton S, Syed Y, Martin JR, Beale R, Treacher D, et al. Low systemic oxygen delivery and BP and risk of progression of early AKI. Clin J Am Soc Nephrol. 2015 Aug 7;10(8):1340-9
• 46. Trager K, De Backer D, Radermacher P. Metabolic alterations in sepsis and vasoactive drug-related metabolic effects. Curr Opin Crit Care 2003 Aug;9(4):271-8.
• 47. Levite M. Dopamine and T cells: dopamine receptors and potent effects on T cells, dopamine production in T cells, and abnormalities in the dopaminergic system in T cells in autoimmune, neurological and psychiatric diseases. Acta Physiol (Oxf). 2016 Jan;216(1):42-89.