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RANDOMIZED CONTROLLED TRIAL
François Lamontagne, Marie-Hélène Masse, Julie Menard, Sheila Sprague, Ruxandra Pinto, Daren K Heyland, Deborah J Cook, Marie-Claude Battista, Andrew G Day, Gordon H Guyatt, Salmaan Kanji, Rachael Parke, Shay P McGuinness, Bharath-Kumar Tirupakuzhi Vijayaraghavan, Djillali Annane, Dian Cohen, Yaseen M Arabi, Brigitte Bolduc, Nicole Marinoff, Bram Rochwerg, Tina Millen, Maureen O Meade, Lori Hand, Irene Watpool, Rebecca Porteous, Paul J Young, Frederick D'Aragon, Emilie P Belley-Cote, Elaine Carbonneau, France Clarke, David M Maslove, Miranda Hunt, Michaël Chassé, Martine Lebrasseur, François Lauzier, Sangeeta Mehta, Hector Quiroz-Martinez, Oleksa G Rewa, Emmanuel Charbonney, Andrew J E Seely, Demetrios J Kutsogiannis, Remi LeBlanc, Armand Mekontso-Dessap, Tina S Mele, Alexis F Turgeon, Gordon Wood, Sandeep S Kohli, Jason Shahin, Pawel Twardowski, Neill K J Adhikari
BACKGROUND: Studies that have evaluated the use of intravenous vitamin C in adults with sepsis who were receiving vasopressor therapy in the intensive care unit (ICU) have shown mixed results with respect to the risk of death and organ dysfunction. METHODS: In this randomized, placebo-controlled trial, we assigned adults who had been in the ICU for no longer than 24 hours, who had proven or suspected infection as the main diagnosis, and who were receiving a vasopressor to receive an infusion of either vitamin C (at a dose of 50 mg per kilogram of body weight) or matched placebo administered every 6 hours for up to 96 hours...
June 23, 2022: New England Journal of Medicine
#2
RANDOMIZED CONTROLLED TRIAL
Chairat Permpikul, Surat Tongyoo, Tanuwong Viarasilpa, Thavinee Trainarongsakul, Tipa Chakorn, Suthipol Udompanturak
Rationale: Recent retrospective evidence suggests the efficacy of early norepinephrine administration during resuscitation; however, prospective data to support this assertion are scarce. Objectives: To conduct a phase II trial evaluating the hypothesis that early low-dose norepinephrine in adults with sepsis with hypotension increases shock control by 6 hours compared with standard care. Methods: This single-center, randomized, double-blind, placebo-controlled clinical trial was conducted at Siriraj Hospital, Bangkok, Thailand...
May 1, 2019: American Journal of Respiratory and Critical Care Medicine
#3
REVIEW
Bijan Teja, Nicholas A Bosch, Allan J Walkey
Septic shock is defined by the need for vasopressor agents to correct hypotension and lactic acidosis resulting from infection, with 30%-40% case fatality rates. The care of patients with worsening septic shock involves multiple treatment decisions involving vasopressor choices and adjunctive treatments. In this edition of "How I Do It", we provide a case-based discussion of common clinical decisions regarding choice of first-line vasopressor, BP targets, route of vasopressor delivery, use of secondary vasopressors, and adjunctive medications...
March 2023: Chest
#4
REVIEW
Kevin M Tourelle, Sebastien Boutin, Markus A Weigand, Felix C F Schmitt
Next-generation sequencing (NGS) has been further optimised during the last years and has given us new insights into the human microbiome. The 16S rDNA sequencing, especially, is a cheap, fast, and reliable method that can reveal significantly more microorganisms compared to culture-based diagnostics. It might be a useful method for patients suffering from severe sepsis and at risk of organ failure because early detection and differentiation between healthy and harmful microorganisms are essential for effective therapy...
October 21, 2021: Journal of Clinical Medicine
#5
REVIEW
Tom van der Poll, Manu Shankar-Hari, W Joost Wiersinga
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to an infection. This recently implemented definition does not capture the heterogeneity or the underlying pathophysiology of the syndrome, which is characterized by concurrent unbalanced hyperinflammation and immune suppression. Here, we review current knowledge of aberrant immune responses during sepsis and recent initiatives to stratify patients with sepsis into subgroups that are more alike from a clinical and/or pathobiological perspective, which could be key for identification of patients who are more likely to benefit from specific immune interventions...
November 9, 2021: Immunity
#6
REVIEW
Jim Tseng, Kenneth Nugent
The shock index (SI) equals the heart rate/systolic blood pressure and has been used to predict clinical outcomes, especially in trauma and surgery patients. The authors reviewed the literature to determine its utility in the management of patients with sepsis and in the prediction of adverse outcomes in these patients. The medical literature was searched using PubMed, Scopus, Web of Science and Google Scholar databases to identify articles in English on the SI in humans. These studies demonstrated that the SI could help evaluate the adequacy of fluid resuscitation and the potential response to additional fluid...
June 2015: American Journal of the Medical Sciences
#7
JOURNAL ARTICLE
Xiaowu Bai, Wenkui Yu, Wu Ji, Zhiliang Lin, Shanjun Tan, Kaipeng Duan, Yi Dong, Lin Xu, Ning Li
INTRODUCTION: This study investigated the incidence of delayed norepinephrine administration following the onset of septic shock and its effect on hospital mortality. METHODS: We conducted a retrospective cohort study using data from 213 adult septic shock patients treated at two general surgical intensive care units of a tertiary care hospital over a two year period. The primary outcome was 28-day mortality. RESULTS: The 28-day mortality was 37...
October 3, 2014: Critical Care: the Official Journal of the Critical Care Forum
#8
RANDOMIZED CONTROLLED TRIAL
Pierre Asfar, Ferhat Meziani, Jean-François Hamel, Fabien Grelon, Bruno Megarbane, Nadia Anguel, Jean-Paul Mira, Pierre-François Dequin, Soizic Gergaud, Nicolas Weiss, François Legay, Yves Le Tulzo, Marie Conrad, René Robert, Frédéric Gonzalez, Christophe Guitton, Fabienne Tamion, Jean-Marie Tonnelier, Pierre Guezennec, Thierry Van Der Linden, Antoine Vieillard-Baron, Eric Mariotte, Gaël Pradel, Olivier Lesieur, Jean-Damien Ricard, Fabien Hervé, Damien du Cheyron, Claude Guerin, Alain Mercat, Jean-Louis Teboul, Peter Radermacher
BACKGROUND: The Surviving Sepsis Campaign recommends targeting a mean arterial pressure of at least 65 mm Hg during initial resuscitation of patients with septic shock. However, whether this blood-pressure target is more or less effective than a higher target is unknown. METHODS: In a multicenter, open-label trial, we randomly assigned 776 patients with septic shock to undergo resuscitation with a mean arterial pressure target of either 80 to 85 mm Hg (high-target group) or 65 to 70 mm Hg (low-target group)...
April 24, 2014: New England Journal of Medicine
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