1519: IMPACT OF TIME TO INITIATION OF STRESS-DOSE STEROIDS ON VASOPRESSOR THERAPY DURATION IN SEPTIC SHOCK

This chapter provides a summary of the landmark study known as the CORTICUS trial. Among patients suffering from septic shock, does low dose hydrocortisone improve mortality? Starting with that question, it describes the basics of the study, including funding, study location, the population studies, number of patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The CORTICUS trial failed to demonstrate a benefit on mortality with steroid therapy among patients with septic shock. Based on CORTICUS and other studies, the Surviving Sepsis Campaign guidelines no longer recommend steroids for all patients with septic shock. Corticosteroids should be considered, however, for patients with septic shock who do not respond to fluids and vasopressor therapy.

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Inotrope and Vasopressor Therapy of Septic Shock

Critical Care Clinics ◽

10.1016/j.ccc.2009.07.003 ◽

2009 ◽

Vol 25 (4) ◽

pp. 781-802 ◽

Cited By ~ 24

Author(s):

Steven M. Hollenberg

Keyword(s):

Septic Shock ◽

Vasopressor Therapy

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Effects of hydrocortisone stress-dose therapy in septic shock (part I): influence on hemodynamic stability and plasma nitrite/nitrate levels

Critical Care ◽

10.1186/cc478 ◽

1999 ◽

Vol 3 (Suppl 1) ◽

pp. P104 ◽

Cited By ~ 4

Author(s):

D Keh ◽

S Weber-Carstens ◽

T Böhnke ◽

C Schulz ◽

M Pettersson ◽

...

Keyword(s):

Septic Shock ◽

Hemodynamic Stability ◽

Dose Therapy ◽

Nitrite Nitrate ◽

Plasma Nitrite ◽

Stress Dose

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1520: TIMING OF STRESS-DOSE STEROIDS IN SEPTIC SHOCK

Critical Care Medicine ◽

10.1097/01.ccm.0000812404.50050.b1 ◽

2021 ◽

Vol 50 (1) ◽

pp. 764-764

Author(s):

Brandon Boelts ◽

klayton ryman ◽

Vivek Kataria ◽

Xuan Wang ◽

Adam Hayek ◽

...

Keyword(s):

Septic Shock ◽

Stress Dose

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A Unique Case of Unilateral Lower Extremity Sparing Systemic Peripheral Gangrene

Case Reports in Vascular Medicine ◽

10.1155/2012/750953 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Alexey Markelov ◽

Steven DeFroda ◽

Leopoldo Baccaro ◽

Jamie Bastidas

Keyword(s):

Septic Shock ◽

Lower Extremity ◽

External Iliac Artery ◽

Artery Occlusion ◽

Upper Extremities ◽

Vasopressor Therapy ◽

Unique Case ◽

Iliac Artery Occlusion ◽

Peripheral Gangrene ◽

Severe Septic Shock

We present here the case of a 70-year-old female who developed a systemic peripheral gangrene in both of her upper extremities (all fingers) and her right foot due to a severe septic shock requiring a systemic vasopressor therapy. Interestingly, the patient’s left foot remained spared from gangrenous changes possibly due to a chronic external iliac artery occlusion and thus the lower concentration of vasopressors in that extremity.

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Effects of stress-dose hydrocortisone therapy in septic shock (part III): monocyte HLA-DR expression and blood interferon-? concentration. Preliminary results of a double blinded, randomized, placebo-controlled cross-over study

Critical Care ◽

10.1186/cc480 ◽

1999 ◽

Vol 3 (Suppl 1) ◽

pp. P106

Author(s):

T Böhnke ◽

C Schulz ◽

D Keh ◽

M Pettersson ◽

S Weber-Carstens ◽

...

Keyword(s):

Septic Shock ◽

Preliminary Results ◽

Hla Dr ◽

Effects Of Stress ◽

Double Blinded ◽

Stress Dose

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Implications of Statin Use on Vasopressor Therapy in the Setting of Septic Shock

Hospital Pharmacy ◽

10.1177/0018578718764932 ◽

2018 ◽

Vol 53 (3) ◽

pp. 152-156

Author(s):

Chelsey M. McPheeters ◽

Jennifer A. Wiedmar ◽

Christina M. Pinkston ◽

Kyle A. Weant

Keyword(s):

Septic Shock ◽

Inflammatory Responses ◽

Control Group ◽

Vasopressor Therapy ◽

Statin Group ◽

Improved Outcomes ◽

Anti Inflammatory ◽

Time Of Admission ◽

Statin Use

Background: Pleiotropic anti-inflammatory and immunomodulatory effects of statins have been associated with improved outcomes in the critically ill population. Objective: To evaluate the implications of prior statin use on the duration of vasopressor therapy in the setting of septic shock. Methods: This was a retrospective, multicenter study of adult patients who were diagnosed with septic shock. Patients were included if they were treated with any vasopressor for greater than 6 hours from the time of admission. The primary outcome was to compare the duration of vasopressor therapy in patients with septic shock with and without previous statin exposure. Results: A total of 88 statin-exposed cases and 205 unexposed controls were included in the analysis. Despite 92% of statin-exposed patients being reinitiated on therapy within 24 hours, the duration of vasopressors did not differ between groups (44 hours, statin group vs 53 hours, control group, P = .51). There were also no mortality differences between the statin group and the controls (40% vs 47%, P = .27). Conclusions: Long-term statin exposure does not impact the duration of vasopressor therapy in septic shock. The lack of differences in clinical outcomes supports the concept that sepsis involves pro- and anti-inflammatory pathways as well as other nonimmunologic pathways. Results lend further credence to the recent conceptualization of sepsis, with complications leading to organ dysfunction caused not primarily due to inflammatory responses but by a dysregulated response to infection.

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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.

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