Critical care : the official journal of the Critical Care Forum
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A heparin-like effect was recently described in infants, children, and adults receiving bivalirudin while supported on extracorporeal membrane oxygenation following cardiopulmonary bypass. This is most likely due to endogenous release of glycosaminoglycans from vascular endothelium and mast cells and is associated with longer duration of extracorporeal membrane oxygenation and an increased incidence of sepsis. Further investigation into this effect should include patients without recent cardiopulmonary bypass, exclude the presence of covalent antithrombin-heparin complexes, and employ a variety of different heparinases for thromboelastography. The phenomenon may partially explain the heterogeneity of anticoagulation requirements in patients on extracorporeal life support.
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Chalmers JD, Pletz MW, Aliberti S (Eds): Community-Acquired Pneumonia. European Respiratory Monographs. Sheffield: European Respiratory Society; 2014, ISBN 978-1-849-84049-1.
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Activation of the sympathetic nervous system has beneficial cardiovascular effects in sepsis, but there is also evidence that sympatholytics have beneficial actions in sepsis. We therefore determined the effect of selective β1-adrenoceptor blockade on cardiac and renal function and cytokine release in ovine hyperdynamic sepsis. ⋯ In sepsis, selective β1-adrenoceptor blockade reduced CO, but not MAP. During sepsis, atenolol did not alter the development of acute kidney injury or the levels of pro-inflammatory cytokines, but enhanced the release of IL-10. Atenolol appears safe in sepsis, has no deleterious cardiovascular or renal effects, and has an anti-inflammatory effect.