***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Patients with cirrhosis and tense ascites treated by paracentesis  alone have a decrease in effective arterial blood volume after ascites removal . Although intravenous albumin is effective in preventing paracentesis induced decreased arterial blood volume , its clinical use is controversial . As paracentesis induces arteriolar vasodilation which plays a role in the development of decreased effective arterial blood volume , administration of a vasoconstrictor ( terlipressin ) could prevent circulatory alterations due to paracentesis . Aims : To perform a pilot study comparing the effects of terlipressin and albumin on effective arterial blood volume in patients with cirrhosis treated by paracentesis for tense ascites . Methods : Twenty patients with cirrhosis and tense ascites were r and omly assigned to be treated by either paracentesis and terlipressin or paracentesis and albumin . Terlipressin ( 3 mg ) or albumin ( 8 g/l of removed ascites ) were administered on the day of paracentesis . Effective arterial blood volume was assessed by measuring plasma renin concentrations at baseline and on the day of hospital discharge ( 4–6 days after treatment ) . Decreased effective arterial blood volume was defined as an increase in plasma renin concentrations on the day of hospital discharge of more than 50 % of baseline values . Results : Irrespective of the treatment group , mean values for plasma renin concentrations at hospital discharge did not differ from their respective baseline values ( p=0.10 ) . Baseline plasma levels of renin concentrations did not differ between the terlipressin and albumin groups ( p=0.61 ) . Changes from baseline in plasma renin concentrations did not differ between groups ( p=0.39 ) . Three patients in the terlipressin group and three in the albumin group developed decreased arterial blood volume . Conclusions : This r and omised pilot study suggests that terlipressin may be as effective as intravenous albumin in preventing a decrease in effective arterial blood volume in patients with cirrhosis treated by paracentesis for tense ascites Purpose To evaluate the effect of milrinone on diastolic function during coronary artery bypass grafting surgery ( CABG ) . Methods Fifty patients undergoing CABG were r and omized to receive a bolus and infusion of milrinone or placebo before cardiopulmonary bypass ( CPB ) until skin closure . Hemodynamic and transesophageal echocardiographic measurements of systolic and diastolic function were obtained . Pulsed wave Doppler measurements of the early ( E wave ) and atrial components ( A wave ) of the transmitral ( TMF ) and transtricuspid ( TTF ) flows , and systolic ( S wave ) , diastolic ( D wave ) and atrial components ( Ar ) of the pulmonary ( PVF ) and hepatic venous blood flow ( HVF ) velocities were performed . Early and atrial components of the mitral ( Em and Am waves ) and tricuspid annulus velocities ( Et and At waves ) were assessed by tissue Doppler imaging ( TDI ) . Assessment of diastolic dysfunction was grade d from normal to severe using a scale score . Results Cardiac index and heart rate were higher in the milrinone group compared to placebo after the administration of study drug ( 2.8 ± 0.6 vs2.1 ± 0.5 L·min-1m-2 ) ( P < 0.0001 ) and ( 67 ± 8 vs 60 ± 12 beats·min-1 ) ( P < 0.05 ) respectively . There were no changes in left and right ventricular diastolic dysfunction scores between study groups . Higher PVF S wave , HVF S wave , TTF A wave and At measured by TDI in the milrinone group compared with placebo suggested an improvement in ventricular systolic and atrial contraction . Conclusion Distinct from its effects on systolic function , milrinone administered before CPB is not with associated improved biventricular diastolic function in patients undergoing CABG.ObjectifEvaluer l’effet de la milrinone sur la fonction diastolique durant un pontage aortocoronarien (PAC).MéthodeCinquante patients subissant un PAC ont été r and omisés à recevoir soit une dose bolus et une perfusion de milrinone , soit un placebo avant la circulation extracorporelle ( CEC ) jusqu’à fermeture de la peau . Les mesures hémodynamiques et échocardiographiques transoesophagiennes des fonctions systolique et diastolique ont été obtenues . Les mesures Doppler pulsées des composantes précoces ( onde E ) et auriculaires ( onde A ) des débits transmitral ( TMF ) et transtricuspide ( TTF ) , et les composantes systolique ( onde S ) diastolique ( onde D ) et auriculaires ( Ar ) des vélocités du débit sanguin veineux pulmonaire ( PVF ) et hépatique ( HVF ) ont été prises . Les composantes précoces et auriculaires des vélocités de l’anneau mitral ( ondes Em et Am ) et de l’anneau tricuspide ( ondes Et et At ) ont été mesurées par Doppler tissulaire ( TDI ) . La dysfonction diastolique a été gradée de normale à sévère sur une échelle de scores . RésultatsL’index cardiaque et la fréquence cardiaque ont été plus élevés dans le groupe milrinone comparé au groupe placebo après la prise du médicament à l’étude ( 2,8 ± 0,6 vs 2,1 ± 0,5 L·min-1m-2 ) ( P < 0,0001 ) et ( 67 ± 8 vs 60 ± 12 battements·min-1 ) ( P < 0,05 ) , respectivement . Il n’y a pas eu de changement dans les résultats de scores de dysfonction diastolique des ventricules gauche et droit entre les groupes d’étude . On a mesuré par TDI des ondes PVF S , HVF S et TTFA ainsi qu’un At plus élevés dans le groupe milrinone que dans le groupe placebo , ce qui suggère une amélioration de la contraction ventriculaire et auriculaire . Conclusion En dehors de ses effets sur la fonction systolique , la milrinone administrée avant la CEC n’est pas associée à une meilleure fonction diastolique biventriculaire chez les patients subissant un PAC OBJECTIVES We aim ed to evaluate the renoprotective role of renal-dose dopamine on cardiac surgical patients at high risk of postoperative renal dysfunction . The latter included older patients or those with pre-existing renal disease , elevated preoperative serum creatinine ( Cr ) , poor ventricular function , hypertension , diabetes mellitus and unstable angina requiring intravenous therapy . METHODS Fifty patients undergoing cardiopulmonary bypass ( CPB ) who fulfilled the entry criteria were prospect ively r and omized into two groups : Group 1 received a ' renal-dose ' ( 3 microg kg(-1 ) min(-1 ) ) dopamine infusion starting at anaesthetic induction for 48 h whilst saline infusion acted as placebo in Group 2 . The anaesthetic and CPB regimes were st and ardized . Urinary excretion of retinol binding protein ( RBP ) indexed to Cr , an accurate and sensitive marker of early renal tubular damage , was assessed daily for 6 days . Additional outcome measures included daily fluid balance , blood urea and serum Cr . Statistical comparisons were made using ANOVA and Mann-Whitney U-test . RESULTS No significant difference was found between the groups in their age , gender , preoperative NYHA class , ejection fraction , baseline serum Cr and duration of CPB and aortic cross-clamping . Renal replacement therapy was not required in any instance . Both groups demonstrated a similar and significant rise in urinary RBP throughout the study period . Dopamine-treated patients achieved more negative average fluid balance than those on placebo ( 5 vs. 229 ml , P<0.05 ) . CONCLUSIONS Renal-dose dopamine therapy failed to offer additional renoprotection to patients considered at increased risk of renal dysfunction after CPB BACKGROUND Dobutamine is commonly used as a means of treating decompensated congestive heart failure ( CHF ) . Although typically effective at improving short-term hemodynamics and symptomatology , the frequent occurrence of arrhythmias and tachycardia is undesirable . In this r and omized , multicenter trial , we compared the safety and clinical effectiveness of the cardiac hormone nesiritide ( human B-type natriuretic peptide ) with dobutamine in hospitalized patients with decompensated CHF . METHODS The study population consisted of 255 patients who were r and omized to 1 of 2 doses of intravenous nesiritide ( 0.015 or 0.03 microg/kg/min ) or dobutamine ( > or = 5 microg/kg/min ) and stratified by means of an earlier history of ventricular tachycardia . Patients were also assessed with 24 hour Holter recordings immediately before and during study drug therapy and by means of signs and symptoms of CHF . RESULTS Dobutamine significantly increased the mean ( 1 ) number of ventricular tachycardia events per 24 hours by 48 + /- 205 ( P = .001 ) , ( 2 ) repetitive ventricular beats per hour by 15 + /- 53 ( P = .001 ) , ( 3 ) premature ventricular beats per hour by 69 + /- 214 ( P = .006 ) , and ( 4 ) heart rate by 5.1 + /- 7.7 beats per minute ( P < .001 ) . These end points were significantly decreased or unchanged in the nesiritide groups . Nesiritide did not increase heart rate , despite a greater reduction of blood pressure . Both drugs were similarly effective means of improving signs and symptoms of CHF . CONCLUSIONS Dobutamine is associated with substantial proarrhythmic and chronotropic effects in patients with decompensated CHF , whereas nesiritide actually reduces ventricular ectopy or has a neutral effect . Compared with dobutamine , nesiritide may be a safer , short-term treatment for patients with decompensated CHF The prophylactic use of small doses of ephedrine may counter the hypotension response to propofol anesthesia with minimal hemodynamic changes . One hundred-fifty patients scheduled for valve surgery were r and omly assigned into five groups ( n = 30 for each ) to receive saline , 0.07 , 0.1 , or 0.15 mg/kg of ephedrine , or phenylephrine 1.5 μg/kg before induction of propofol-fentanyl anesthesia . After induction , patient receiving ephedrine had higher mean arterial pressure , systemic vascular resistance ( SVRI ) , cardiac ( CI ) , stroke volume ( SVI ) , and left ventricular stroke work ( LVSWI ) indices . Patients received 0.15 mg/kg of ephedrine showed additional increased heart rate and frequent ischemic episodes ( P < 0.001 ) . However , those who received phenylephrine showed greater rise in SVRI , reduced CI , SVI , and LVSWI and more frequent ischemic episodes . We conclude that the prophylactic use of small doses of ephedrine ( 0.07 - 0.1 mg/kg ) is safe and effective in the counteracting propofol-induced hypotension during anesthesia for valve surgery Background During coronary anastomosis in off-pump coronary artery bypass surgery ( OPCAB ) , hemodynamic alternations can be induced by impaired diastolic function of the right ventricle . This study was design ed to examine the effect of milrinone on right ventricular function and early outcomes in patients undergoing OPCAB . Methods Forty patients undergoing OPCAB were r and omly assigned in a double-blind manner to receive either milrinone ( milrinone group , n = 20 ) or normal saline ( control group , n = 20 ) . Hemodynamic variables were measured after pericardiotomy ( T1 ) , 5 min after stabilizer application for anastomosis of the left anterior descending coronary artery ( LAD , T2 ) , the obtuse marginalis branch ( OM , T3 ) , the right coronary artery ( RCA , T4 ) , 5 min after sternal closure ( T5 ) , and after ICU arrival . The right ventricular ejection fraction ( RVEF ) and right ventricular volumetric parameters were also measured using the thermodilution technique . For evaluation of early outcomes , the 30-day operative mortality and morbidity risk models were used . Results There was no significant difference in hemodynamic variables , including mean arterial pressure , between the 2 groups , except for the cardiac index and RVEF . The cardiac index and RVEF were significantly greater at T3 in the milrinone group than in the control group . Conclusions Continuous infusion of milrinone demonstrated a beneficial effect on cardiac output and right ventricular function in patients undergoing OPCAB , especially during anastomosis of the graft to the OM artery , and it had no adverse effect on early outcomes BACKGROUND A rapid heart rate ( HR ) during atrial fibrillation ( AF ) and atrial flutter ( AFL ) in left ventricular ( LV ) dysfunction often impairs cardiac performance . The J-L and study was conducted to compare the efficacy and safety of l and iolol , an ultra-short-acting β-blocker , with those of digoxin for swift control of tachycardia in AF/AFL in patients with LV dysfunction . METHODS AND RESULTS The 200 patients with 
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A reduction in mortality was associated with inotrope/vasopressor therapy use in setting s of vasoplegic syndromes , sepsis and cardiac surgery .
Levosimendan was the only drug associated with improvement in survival .
Subgroup analysis did not identify any groups with increased mortality associated with inotrope/vasopressor therapy .
Our systematic review found that inotrope/vasopressor therapy is not associated with differences in mortality in the overall population and in the majority of sub setting