Concomitant vasopressin and hydrocortisone therapy on short-term hemodynamic effects and vasopressor requirements in refractory septic shock

Refractory septic shock develops in 6–7% of sepsis patients with short-term lethality rate of more than 50%. It is necessary to assess the effectiveness of intensive therapy methods used in this case.The objective of the review: to analyze publications on the intensive care of refractory septic shock.Results. 56 studies published in the period from January 1, 1990 to September 1, 2020 were analysed, they reflect the effectiveness of some methods used for management of refractory septic shock (treatment of the underlying disease, liquid bolus, the use of norepinephrine, adjuvant therapy, management of metabolic acidosis). The second part of this article will reflect the evaluation of the effectiveness of other approaches to the treatment of this complication.

Download Full-text

Refractory Septic Shock (Part 2)

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2021-18-3-79-86 ◽

2021 ◽

Vol 18 (3) ◽

pp. 79-86

Author(s):

L. L. Plotkin

Keyword(s):

Septic Shock ◽

Methylene Blue ◽

Intensive Care ◽

Intensive Therapy ◽

Vitamin B ◽

Vasopressor Therapy ◽

Short Term ◽

Refractory Shock ◽

Short Term Mortality ◽

Refractory Septic Shock

Refractory shock is the shock that does not respond to vasopressor therapy. Refractory shock with a short-term mortality rate of more than 50% is diagnosed in 6-7% of critically ill patients. There is an objective need to Investigate methods of intensive therapy for refractory septic shock.The objective of the study: to analyze literature data on the intensive care of refractory septic shock.Results. The second part of the article analyzes 37 studies, both Russian and foreign ones devoted to the intensive care of refractory shock. At present, based on the analysis of the publication, it is impossible to draw reasonable conclusions about the advantage of one or another method of intensive therapy for refractory shock (veno-venous hemofiltration, the use of angiotensin II and vasopressin, as well as methylene blue, vitamin B12, ECMO) over basic therapy.

Download Full-text

Short-term cardiovascular effects of plasmapheresis in norepinephrine-refractory septic shock

Intensive Care Medicine ◽

10.1007/s00134-002-1375-6 ◽

2002 ◽

Vol 28 (8) ◽

pp. 1164-1167 ◽

Cited By ~ 10

Author(s):

Karin Ataman ◽

Michaela Jehmlich ◽

Sabine Kock ◽

Sabine Neumann ◽

Matthias Leischik ◽

...

Keyword(s):

Septic Shock ◽

Cardiovascular Effects ◽

Short Term ◽

Refractory Septic Shock

Download Full-text

Study on the Efficacy and Timing of ECMO Therapy in Children With Refractory Septic Shock

Case Medical Research ◽

10.31525/ct1-nct03948048 ◽

2019 ◽

Author(s):

Keyword(s):

Septic Shock ◽

Refractory Septic Shock ◽

Ecmo Therapy

Download Full-text

Short-term Hemodynamic Effects of Immunoadsorption in Dilated Cardiomyopathy

Circulation ◽

10.1161/01.cir.95.8.1994 ◽

1997 ◽

Vol 95 (8) ◽

pp. 1994-1997 ◽

Cited By ~ 122

Author(s):

Wolf V. Dörffel ◽

Stephan B. Felix ◽

Gerd Wallukat ◽

Stefan Brehme ◽

Knut Bestvater ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Hemodynamic Effects ◽

Short Term

Download Full-text

Validation of the pediatric refractory septic shock definition: post hoc analysis of a controlled trial

Annals of Intensive Care ◽

10.1186/s13613-021-00822-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Luc Morin ◽

Karthik Narayanan Ramaswamy ◽

Muralidharan Jayashree ◽

Arun Bansal ◽

Karthi Nallasamy ◽

...

Keyword(s):

Septic Shock ◽

Intensive Care ◽

Neonatal Intensive Care ◽

Controlled Trial ◽

Receiver Operating Curve ◽

Double Blind ◽

Post Hoc Analysis ◽

Prognostic Accuracy ◽

Refractory Septic Shock ◽

Post Hoc

Abstract Background The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) developed and validated a definition of pediatric refractory septic shock (RSS), based on two septic shock scores (SSS). Both bedside SSS (bSSS) and computed SSS (cSSS) were found to be strongly associated with mortality. We aimed at assessing the accuracy of the RSS definition on a prospective cohort from India. Methods Post hoc analysis of a cohort issued from a double-blind randomized trial that compared first-line vasoactive drugs in children with septic shock. Sequential bSSS and cSSS from 60 children (single-center study, 53% mortality) were analyzed. The prognostic value of the ESPNIC RSS definition was tested for 28-day all-cause mortality. Results In this septic shock cohort, RSS was diagnosed in 35 patients (58.3%) during the first 24 h. Death occurred in 30 RSS patients (85.7% mortality) and in 2 non-RSS patients (8% mortality), OR = 60.9 [95% CI: 10.5–676.2], p < 0.001 with a median delay from sepsis onset of 3 days [1.0–6.7]. Among patients diagnosed with RSS, the mortality was not significantly different according to vasopressors randomization. Diagnosis of RSS with bSSS and cSSS had a high discrimination for death with an area under the receiver operating curve of 0.916 [95% CI: 0.843–0.990] and 0.925 [95% CI: 0.845–1.000], respectively. High prognostic accuracy of the bSSS was found in the first hours following intensive care admission. The best interval of prognostication occurs after the 12th hour following treatment initiation (AUC 0.973 [95% CI: 0.925–1.000]). Conclusions The ESPNIC refractory septic shock definition accurately identifies, within the first 6 h of septic shock management, children with lethal outcome.

Download Full-text

Venoarterial extracorporeal membrane oxygenation as mechanical circulatory support in adult septic shock: a systematic review and meta-analysis with individual participant data meta-regression analysis

Critical Care ◽

10.1186/s13054-021-03668-5 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Ryan Ruiyang Ling ◽

Kollengode Ramanathan ◽

Wynne Hsing Poon ◽

Chuen Seng Tan ◽

Nicolas Brechot ◽

...

Keyword(s):

Septic Shock ◽

Extracorporeal Membrane Oxygenation ◽

Mechanical Circulatory Support ◽

Meta Analysis ◽

Left Ventricular ◽

Adult Patients ◽

Circulatory Support ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Refractory Septic Shock ◽

Va Ecmo

Abstract Background While recommended by international societal guidelines in the paediatric population, the use of venoarterial extracorporeal membrane oxygenation (VA ECMO) as mechanical circulatory support for refractory septic shock in adults is controversial. We aimed to characterise the outcomes of adults with septic shock requiring VA ECMO, and identify factors associated with survival. Methods We searched Pubmed, Embase, Scopus and Cochrane databases from inception until 1st June 2021, and included all relevant publications reporting on > 5 adult patients requiring VA ECMO for septic shock. Study quality and certainty in evidence were assessed using the appropriate Joanna Briggs Institute checklist, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, respectively. The primary outcome was survival to hospital discharge, and secondary outcomes included intensive care unit length of stay, duration of ECMO support, complications while on ECMO, and sources of sepsis. Random-effects meta-analysis (DerSimonian and Laird) were conducted. Data synthesis We included 14 observational studies with 468 patients in the meta-analysis. Pooled survival was 36.4% (95% confidence interval [CI]: 23.6%–50.1%). Survival among patients with left ventricular ejection fraction (LVEF) < 20% (62.0%, 95%-CI: 51.6%–72.0%) was significantly higher than those with LVEF > 35% (32.1%, 95%-CI: 8.69%–60.7%, p = 0.05). Survival reported in studies from Asia (19.5%, 95%-CI: 13.0%–26.8%) was notably lower than those from Europe (61.0%, 95%-CI: 48.4%–73.0%) and North America (45.5%, 95%-CI: 16.7%–75.8%). GRADE assessment indicated high certainty of evidence for pooled survival. Conclusions When treated with VA ECMO, the majority of patients with septic shock and severe sepsis-induced myocardial depression survive. However, VA ECMO has poor outcomes in adults with septic shock without severe left ventricular depression. VA ECMO may be a viable treatment option in carefully selected adult patients with refractory septic shock.

Download Full-text