Tag: septic shock
Norepinephrine in Septic Shock
Norepinephrine (NE) is both an alpha1- and beta1-agonist, and is therefore able to increase vascular tone and contractility. Recent guidelines recommend NE as the first-line vasopressor in septic shock. However, because septic... read more
Terlipressin vs. Norepinephrine As Infusion in Patients With Septic Shock
In this multicentre, randomised, double‑blinded trial, we observed no difference in mortality between terlipressin and NE infusion in patients with septic shock. Patients in the terlipressin group had a higher number of... read more
Principles of Fluid Management and Stewardship in Septic Shock
There are only four major indications for fluid administration in the critically ill: resuscitation, maintenance, replacement and nutrition (enteral or parenteral). In this review, a conceptual framework is presented looking... read more
Effect of Levocarnitine vs Placebo as an Adjunctive Treatment for Septic Shock
In this dose-finding, phase 2 adaptive randomized trial, patients with septic shock and moderate organ dysfunction were treated early in the course of illness with low (6 g), medium (12 g), or high (18 g) doses of levocarnitine... read more
Long-term outcomes in patients with septic shock transfused at a lower versus a higher haemoglobin threshold
Long-term mortality rates and HRQoL did not differ in patients with septic shock and anaemia who were transfused at a haemoglobin threshold of 7 g/dl versus a threshold of 9 g/dl. We may reject a more than 3 % increased hazard... read more
Septic Shock: Innovative Treatment Options in the Wings
Vitamin C, angiotensin-II, and methylene blue are emerging options on the cutting edge of refractory septic shock treatment that require more investigation, but nevertheless appear promising, Rishi Rattan, MD, said at the... read more
The impact of age on the innate immune response and outcomes after severe sepsis/septic shock in trauma and surgical ICU patients
Aged, critically ill surgical patients have greater organ dysfunction and incidence of adverse clinical outcomes after sepsis. Biomarker profiles suggest an immunophenotype of persistent immunosuppression and catabolism.... read more
Patterns of Early Crystalloid Resuscitation Provided to Sepsis and Septic Shock Patients
Patterns and Outcomes Associated With Timeliness of Initial Crystalloid Resuscitation in a Prospective Sepsis and Septic Shock Cohort. Crystalloid was initiated significantly later with comorbid heart failure and renal failure,... read more
Approach to the Critically Ill Child: Shock
If you mainly treat adults or both adults and children like me, then you have probably heard the (very annoying) quote, "kids are not just small adults", and so I won't say it again. Well, I guess I just did, but at least... read more
Hydrocortisone plus Fludrocortisone for Adults with Septic Shock
The use of steroids in critically ill patients continues to be controversial. Whilst there are signals for improved cardiovascular parameters, this did not translate to clear mortality benefits. The most recent of these trials... read more
Do phenylephrine and epinephrine require central access?
Until recently I believed that prolonged vasopressor administration requires a central line, to avoid extravasation. I lumped together all vasopressors, treating them all as equal. I used the occurrence of an extravasation... read more
Silent Space
Exhausted at the end of a busy week on service in the intensive care unit (ICU), the fellow and I are on our way to the conference room to debrief the week. The overhead code alarm disrupts the temporary lull in activity... read more
Intensive Care Medicine in 2050: Vasopressors in Sepsis
Vasopressors are used in sepsis when hypotension is assumed to be mainly due to a decreased arterial tone. However, the appropriate time to initiate vasopressors is not clearly defined, and fluid administration is most... read more
New World Sepsis Day Infographics
The new World Sepsis Day Infographics are now available for download, just in time for World Sepsis Day this Thursday. Please download them and feel free to use them as you see fit, on your social media channels, printed... read more
Hospital Variation in Risk-Adjusted Pediatric Sepsis Mortality
Margaret Parker, MD, MCCM, speaks with Stefanie G. Ames, MD, about the article "Hospital Variation in Risk-Adjusted Pediatric Sepsis Mortality," published in the May 2018 issue of Pediatric Critical Care Medicine. Dr. Ames... read more
Haemoglobin concentration and volume of intravenous fluids in septic shock in the ARISE trial
Haemoglobin concentration decreases during resuscitation from septic shock, and has a significant but weak association with the volume of intravenous fluids administered. Median (IQR) haemoglobin concentration at baseline... read more
It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock
The administration of a continuous infusion of hydrocortisone to a general population of patients in septic shock on mechanical ventilation cannot be recommended at this time. The authors conclusion that glucocorticoids do... read more
Predicting the Requirement for RRT in Intensive Care Patients with Sepsis
Sepsis is one of the most frequent causes of acute kidney injury (AKI) in critically ill patients, with initial organ impairment often followed by dysfunction in other systems. Renal dysfunction may therefore represent one... read more
