الفهرس | Only 14 pages are availabe for public view |
Abstract Abstract Introduction: Shock is a state of cellular and tissue hypoxia due to reduced oxygen delivery and/or increased oxygen consumption or inadequate oxygen utilization. This most commonly occurs when there is circulatory failure manifested as hypotension (ie.,reduced tissue perfusion). Shock is initially reversible, but must be recognized and treated immediately to prevent progression to irreversible organ dysfunction. Aim of work: To clarify the recent updates in diagnosis and management of refractory shock in the intensive care unit. Objectives: To highlight pathogenesis of Refractory cardiogenic ,distributive ,hypovolemic and obstructive shock, and Recent updates in diagnosis and treatment of each type . Data source: Medline database (PubMed .,Medscape , Science Direct , EM-Portal)and all material available on internet till 2017. Conclusion : Recent updates in refractory shock includes the vasopressor levosimendan in combination with noradrenaline, Growing evidence supporting ECMO as a new interventional tool to improve the prognosis. Impella 2.5 is associated with significant early survival benefit. New method s for monitoring those patients should include macrocirculatory and microcirculatory parameters. One of the most important landmarks in 2016 was the publication of the new edition of the Surviving Sepsis Campaign guidelines |