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Update in intensive care medicine: Cardiogenic shock
Available online 4 June 2024
The medical treatment of cardiogenic shock
Tratamiento médico del shock cardiogénico
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Manuel García-Delgadoa,b, Raquel Rodríguez-Garcíac,d,e,
Corresponding author
raquelm.rodriguez@sespa.es

Corresponding author.
, Ana Ochagavíaf, Maria de los Ángeles Rodríguez-Estebanc
a Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
b Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
c Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
d Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain
e CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Spain
f Servicio de Medicina Intensiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Table 1. Supportive treatment scheme for multiple organ dysfunction in cardiogenic shock.
Table 2. Basic measures for Zero Pneumonia.
Table 3. Basic measures for Zero Bacteremia.
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Abstract

Cardiogenic shock is characterized by tissue hypoperfusion due to the inadequate cardiac output to maintain the tissue oxygen demand. Despite some advances in cardiogenic shock management, extremely high mortality is still associated with this clinical syndrome. Its management is based on the immediate stabilization of hemodynamic parameters through medical care and the use of mechanical circulatory supports in specialized centers. This review aims to understand the cardiogenic shock current medical treatment, consisting mainly of inotropic drugs, vasopressors and coronary revascularization. In addition, we highlight the relevance of applying measures to other organ levels based on the optimization of mechanical ventilation and the appropriate initiation of renal replacement therapy.

Keywords:
Cardiogenic shock
Medical treatment
Coronary revascularization
Inotropic therapy
Vasopressors
Mechanical ventilation
Resumen

El shock cardiogénico es un estado de hipoperfusión tisular provocado por la incapacidad del corazón para mantener un gasto cardíaco adecuado a la demanda tisular de oxígeno. A pesar de los avances en el manejo del shock cardiogénico, la mortalidad asociada a este síndrome continúa siendo elevada. Su tratamiento se basa en la estabilización inmediata de los parámetros hemodinámicos mediante la atención médica y el empleo de soportes circulatorios mecánicos en centros especializados. Esta revisión tiene como objetivo conocer el tratamiento médico actual del shock cardiogénico, compuesto principalmente por fármacos inotrópicos, vasopresores y la revascularización coronaria. Además, se detalla la importancia de la aplicación de medidas a otros niveles, basadas en la optimización de la ventilación mecánica y el inicio adecuado de las técnicas de depuración renal.

Palabras clave:
Shock cardiogénico
Tratamiento médico
Revascularización coronaria
Tratamiento inotrópico
Vasopresores
Ventilación mecánica

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